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Di C e? 10.31W FL19;Z0 .EST R'05tiVIL1.E P.3i3 <br /> APPLICATION <br /> tim JQAQUIF COUNTY rVELIC EWA= S8liVICES <br /> ENVIRUMENTAL HSALM DIVISION <br /> 445 AT SAH JOAQ TI$, IaSM (209)468-340 P*t2,ot M6sF-O/ <br /> P 0 sox 2009, MCKT Al, CA 06201 <br /> p "xT R4OTAFR t YTtATt i'lU'NT D,(� '� TAfTIT[tYp <br /> CCcmmplete 1n TrlplicateJ <br /> Applltlticz 1s "?,w aedem so Jalqull oci ty fat a pewit m Coioaawt aovJ lmanu tLn uar•E berth d ciltnd, This <br /> sp3loatim is a&" is emailla o v tb a" .1o.4ctn O .wy DreiPbaes N.. 5,49 a.ed 1862 and the Ta.leA ane aee.Ant w, er Sea <br /> Joagnln Couab Pwout Seslu servime. <br /> yob Ane1e1. <br /> oly 6*}r-. Tot W WACt.coea i�L ado y[�a <br /> om.W'e Nemo ,$.,�P��o.kaa�'s�,.,�gt'rart �Fyel P}�.Se.I�.,,h61 fFe3.1(Ti+s, Pl 6S O t <br /> Fp. Gr W: rK..t /t2pyrG r:t s ✓� 95��Y <br /> CorRroctx Address a9 Tf 6 LdcA NC.65 Lr/.Pi 7.-624 <br /> n•E OF WELLlPD.CIP: NEW WELL ❑ WELL AFPLACEMENT D OESTAuumm 0 W, or awftes mul 0 <br /> PUP&JNSTALUpTMU ❑ SYSTEM REPAIR C OT"S� S rr its rse+t G <br /> I DISTANCE TO NEAREST' SEPTIC TANK -'T-10 SEWER LtNts >,,270 DISPOSAL FLD.1 7 - PSOP. LME f <br /> PoUNDAT1ott _w_L.— ABRICULTUR!w2Lt __)�PIA'07MER WELL,- PITSISUMPS <br /> INTYNOED USE TYPE OF WNELL PWOUE d AREA CONSTRU=M SPfC]MATOWS <br /> CI Irdaslral ❑Open lletbm d Manbta OFa.al Wal E.WOw T- Ow.of wal Gaeig <br /> i 0 DyRytYrJpdi O t?raoA Pati 0 Trry Type PI Caring_ LVA SaedficaMar+ <br /> 19 Plbk •JZqOlher r)Doha Depth M C Vut 1 - t-�� Type d r vat r'.4&1d <br /> I I In+pWim t.li-APMM. Daplh I i Ea-nm Surlae.9"I=Wrye�s <br /> FiAplif Wont Dons ' Type of Pump "-A_ H.P. Sbq W" Pone re-ffiv+tZ. n\ <br /> V42 OefOUGion 0 WON Dom,e>s 2,11 dlftalu$itnteriba A bepth T I V <br /> IVA Depth idles ElateSla3 i Depth <br /> I TYPE F SCM 1e3119: PENT INSTALLATION l I RtPAIRrAUlPT1ON I I DESTREFFOr1 f I IN.septic won,pawakl d d p.epo salad k U � <br /> owalobw w"tin 2w I=.i <br /> nldl ser. Rbrdsnao,,,..,. Cwnws.eiat— other <br /> I Nw bo ad Tiring onks,— RYmw of b.drp <br /> the woo,of Pat w a eaoo .4 a I'M; WSW wt";.wPth <br /> SEPTIC TANK 0 TVWWq CaaadrV Ne. corn rwrlb <br /> PKG.TAEATMENT PLT.❑ "abed of Dio e <br /> 1:14:I m to rw&w: WeP_ _, PPordeha I P'opeR4 Lm <br /> LEAQtiUNG UNE C` No.8 Lerpth at ids Tonal <br /> FILTH BED ❑ aflame so nowlzt: Well FO we"A 1'rglerfT Lite <br /> CW PITS 1 <br /> •�•'•� (IepF N'ae Number cc�� <br /> sulirs 41 Dilaarru m,asaet W.1 Fan.a rr""L... <br /> DISPOSAL MINDS ❑ <br /> I h.na„r:,orli ,char I ha.a ImParsa I"rppacwoa area Mat the wore vN be do-. nt aeoenlhwe rut% San Jaapui.COIrary W donam r.am wm, Ma <br /> Mea and McAssmlp of we San Jonwin CoastT <br /> /Wee naabt&bows"wo's to"am Ceram 7M felelwtg:'i Comy Ihm is the Parlwffmce of rhe wnb fm bt&h as'l pMpi4 a M&Ad,I"Mf <br /> *MOW it svcOh avaner an m bamw athlect m wwkrrlwfa ebllbepmien Owe at rA&M w.-cmeaeta s Rana mr>„tsm.erPcer®>iyl.oe.w <br /> MWM role I"OV IRB!^t""*V Ihat in the pat WnW"of Lha wmN fa.Wltiah INS petma o IOlbdr I*WN err91o1 Iewmxvg WA*U W W m mwo onhpw <br /> n 1 1 <br /> Lima le. of t.rsMy,•• <br /> The apoic"I nWqak tar*_mgWYard inspncuons. Complete anwte on rele�m 14, <br /> .,� (i_ <br /> sowed x r_Two:—. jwbCllgl...e r Door f2f <br /> li bZPARTMENT USE OULV <br /> _I ApplKaept Acttpbd M OMa I�' A.N �`� . <br /> r <br /> i PN w Omit Ina/ap kn M Oar fwt sale" M am <br /> ���s +�- Z5-45 Co.)., 1 <br /> Ae�tienr COrr.narMl: tiru C �Y� <br /> APPIIn.rrt - ➢etnrm .11 coPlea tee: Item JPleNil Cbrntl pab)Ac lellth &Rft <br /> Eevlirlal6a tai >�3tL <br /> SCIr Perwltr�SerTi <br /> 1!D n Sae doagnlay O NOS SOmi. Stke, CA 96ffi1 <br /> IRS AMDUNT DCE AfeWW REWMD Iw9FD aT naTF Pmm-rho. <br /> ze'd BET074460ZT <br /> 01 n3TS uI/6uilll-ja Gga_ig Woo U WcGB:ZT VGGT-£Z-ZT <br />