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APPLICATION <br /> SAN icyAQuim cowrY PuEmIC MUL721 SBUICW <br /> ]MYIRUNasatlaTAL HBALTZ DIVISION <br /> 445 N S" JOAQUIN, PATS (206)468-3420 SAX (7-&%444 o i3B <br /> P O BOX 2006, SrOIXTUN, CA 05201 <br /> I YEAR <br /> (Complete in 'triplicate <br /> Appuwt..M to lrccle Aatt.te Eau Jatau;L COImEY TDT A vtmit to coatsvet and/ra iata71 the mak bA n 6rs=lbed. -T.Ls <br /> MpLlc"L u Is 39tde In eWpue with aac .iatquie GmMy Ordtmnee We. 549 eva 1866 need %k a Atltm 8396 9eptiat%— or say <br /> Jaepsim ubualwA�ctrur 9s1tE 68rrLCgee. <br /> j <br /> :aa AdaraN ; A d; / cvnF U�tb L nrv7 57a`Awn L)ot ititrlpc�e.Ae Z�` �JD�i �h2 <br /> Ownro'e N.P,. 5haA Oil f,�6..,en.; Add,a. L'.�? .i riGC'1AccNd. C+4 <br /> 475 L 1. h-s 4vt R�4 <br /> '4i :d 2906 Lk Tnt. fcS�Y 07 <br /> TYPE Of WELLIPUMP NfW WELL ❑ WELL REPLACEMENT M OISTR.KTiOM 6 Out Of 9e1-•tre Wu ❑ <br /> PUMP INSTALLAjTIOON1 ❑ SYS7MA NPAtR C OT"EA ke p m1tanAr weu <br /> OISTANCF TO NEAREST: SEPTIC TANK ,GlG-.--- !WEFT LW6S 7 ✓ O' DISPOSAL F!D Z-a PROP. LINE L <br /> FOLIROATION AGRICULTURE WELL OTHER WELL jj% PITS05LW.PS — <br /> INTENDED USE TYPE OF WELL FRDRLEM AREA CONSTRUCTION SPECIFICATIONS _ d I e <br /> Cd I rndusma Opea Bottom 0 MNa01a. feral <br /> ace Dio.of Wet!EncaYioDn ,q ' a. a <br /> C DeeNaw)Pmau G Graver Park 0 row Typo of Gump—VL cy�.. Bxdlipsora—�� <br /> 1 !RC. 1 I/C�qMI!er r DNu Depth ai Grow Seel s4la, feed Trpa r:.-... �t...�r.0 <br /> I 1 Im"Te;n y4 A�pef, Dep�tthtsA1 I Ee&cnm $0.1206 SW 1.321011&f�� <br /> fmpw~e Omte 0 Type of rmv 1, n-P. stere teaer rime. ' <br /> Wax OatOucom 0 War piamater Seauft 1aEC'fAl i DEVth <br /> i-"/f Deem 1 r .rtax Ptucr HLUT146l A VWNI <br /> TYPY.OF SEPTIC WORK: NEW SiSTALLATION I I REPAMiADOITION I , DESTRUCTeON i I INe tapao eYstem oOift 1�d a v.M11r serve+a <br /> aoeaaue tngSA 2W fea1.1 <br /> inara{atiett ai twrn: I'Ngdedp._... Coa'aetrwt_ Qtiter _ `, <br /> i Nomoer d 4Yen uuu: .__.._ Nunlre d mm.e I T' <br /> Chatovev of epll w a empofl of S kat: Wan u61e wpm ( n <br /> SEPTIC TANK a 7YPv7Wg CapaeAl No.co eLaft t t <br /> I PRO, TRlATMMr PLT,0 <br /> 1/64106 d QaPtpeal <br /> Ottw,o m reeetea:: Well foundation FYoaaM tcn <br /> LEACteNQ LINE D Nd. 6 Lerotb pt Alas Total*rgwm <br /> FILTER BED ❑ D'atanre v nt39t>it: VWa FarntlaAen Pto39eetY lime <br /> 6E WT! I 1 Dant* <br /> SLHAPsae fl�rrtar <br /> 6112!" Li ORLT4a b deft: We Ka,r,dnenn PFoptM Lbw <br /> OMPMALL TONDS O <br /> I l atebl randy drat I he, pcepa an Itnt 2mbmm ane eui the R9et PW M voett In trocal nea errh sfe JaaTt:n em.ory o'clowcm emote Nies. aec <br /> 'Was Na"Gina aeees d Imo Ban imum anceta <br /> NIM Ott,per or 40~atWI,&SoWtLn OpeorS6 we 10➢ee'ai g:'I fteWV lhei m Uw prltentenn d The work Ier W&Ch put Parrett a as39e41.I Ahal em <br /> employ am pmaoP in wjM rrSeew at m becpnn PAYSG[to W6teMd'E 0WWW hM IM CI CNrpRH."COritraalors Afrhp ar W*WmracwV ajp e1 <br /> wnMla <br /> an laMpMkr:.•I uretymate,"pemarmem at metanh mr AWh me pem.tw awxd.laM 2nVkYP4ff1m+awaj1XAv w.xlmat'ammpen;a. <br /> tivt tern <br /> Try M�frtalt of LaEfyrgja^ <br /> -L L kt as �id,e. CocoPbw dmww4 m rwone ada. <br /> SgtadY L.-�_ i � Tide'. <77sa^.a-Q_._17y/n �-4 -e�- �.. pYd1' IG�23/st� <br /> FOR OEPA7ITMEW USE ONLY <br /> Dam 12- 2 Aro, 35,E <br /> pk er meeee ieap.if39rt De �� Dm FSM Yupeeaart k f Dm <br /> Aftkm N Der ,w HV ' SI TS `,'moi, <br /> Applfoact - 8eetere all copies to: Rae .Leageetee CooeetT P 1, K"ata 3a"A. <br /> xaosfvmredtal sealth Iere2Claen1ee5 <br /> 245 p "n .Toegc Lo, P O It= %elft. O-_tn, at 95201 <br /> FEE <br /> PWOC -Moo*T PWAltplRif�Rj9eTT<� 08MRW Py DATE FERLIT NO. <br /> .sr U4tf evv...su� � . r L>.�D �j�q IZ..Z.3.11y <br /> I <br /> £0'd 8£TOPSIP60ZT 01 n3E5 uIi6ulIIT-CI 66a,j WMW Wcr.O:ZT p66T-£Z-ZT <br />