Laserfiche WebLink
APPLICATION FOR PERUIT <br />,j <br /> SAN JOAQCJ IN COUNTY PC1BI�I C HEALTH SERVICES. i <br /> ENV I RORMUTAL <br /> ,BL <br /> DIVISION <br /> P o BOX 2009', STOW$TON, CA 95201 <br /> (200) , 464-3447 <br /> t <br /> Cosnplate_ 'fit} Txiplic&ta3 r <br /> APP14vlLioa to hereby P-mo." flap J <br /> spPlit:atioa is sae n c 1 PEQuiati G4ullty for b'�er1al� `o conetruat`t<nt{/or ID01434`tho vtlr4 herein daecribod. This <br /> ;arlce With f}er[+ J9"44a 99411 Qr44W99 qv. 549 f+ad'ifl48 the Rules sad AeSulalcions of Ban <br /> Joaqulu Country Publle lie aar-cuss. <br /> .� . . t-f <br /> ,fob Addraii � C(IY� 1.96 EjlsO/AcrCagO 1Z �G <br /> W8,j±.L A Z��ha <br /> Ownar's Noma Address /N Phone <br /> Conlraclor' �N dQrEji s E :; <br /> A Litsn&4 1�vs/ZZG 8 Phone -jr-6&2- <br /> TYPE OF W LL/PUMP: NEW WELL q WELL 119PLACEMENT i DESTRUCTION 0 Out; of service W011 b. <br /> PUMP INSTALLATION 0 r OTHE <br /> ( 4 SY$TfM REPAIR L� } i R W S " ri weal L3 <br /> DISTANCE FD NEAREST:f$ERTIC TANK ' <br /> . SEWER LINES DISPOSA FLD. ,y/� "k r IAF. <br /> FOUNDATION IL ��_ PROP."LINE' <br /> AGRICULTURE WELD ..- OTHER WELL _ PITSI 11IIlk <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> 11 Industrie( ❑ Opan 8oltorn '�— � {" <br /> Morliocl Pit, Of Well 99co. lion pti, f V✓aA Go91ng �"}• f11+ <br /> Domestic/Priyelf Cl Grovel Ppck r <br /> Q Public 7r}cy _ TYP"tt P_IlGeainS v�� SP4cilicElivn# <br /> I:I Other f� Deice DvPlh pl RroNt Saal <br /> u lui�}ation I TyPi of Grvul <br /> "7+-� ApNla+l. Depth QR#SQm SurfiC_�' eul lnylellp4lY.L f <br /> R01I Work Dons U Typo of Pump — - H.P. - <br /> Wef!Dier(ucl(on ❑ Well Diameter — _ Aetkllti; 1lstEil►3 fi peytit Male Work Qone <br /> Depth r'• YiGller )4vorlsl # Depth <br /> 1 R OF SEPTIC YIIORK-, NEW'INSTALLATION A IREPAIWAADITION [�ESTRUCTIO <br /> N -'Ove ae LIC l i 2 <br /> in�tll _ � rv1:��A_li(d4aci��' "��.�` '' � •_ '�iVi!(ibl0 w(Ihin ZOO=10I#� PNy4�iawir is. <br /> ^Number of GwNum <br /> units: . Number 91 bed(opmO <br /> Chllracser pl eoq 19 f <br /> SEPTIC TANK. ❑Ih pl /Mr .,: . . Wiler I401�: . <br /> PKG. TREATMENT PLT.❑ q mpirEminti <br /> Dlstonce to �re51: well i M."hel! m <br /> Founds ---� PtgRo±jY 1,(n9. e. ,� <br /> V JE <br /> LEACHING LINE �- 1) , <br /> Cl No. b Length 9[ linea <br /> FfLTER HD 1 041inge to nTotal Iernglh/ai:9 <br /> well FoYnl�4slon <br /> ----_ _ PIpPe0'Y LA COUNTY" <br /> SEEPAGE PITS Depth y sig _ I�SERVICES <br /> SUMPS LI Distincq io n�1na�. '._. Wil�...« .: `_. :: _,,� <br /> DIS P L PONDS ! e Foundation" .._ °' k <br /> p Property t my l '►�A; •+ <br /> i fr`eby codify Ifial I hsir - <br /> 4 prepared {h(ql �pplics;Ign incl that the Work will be don@ (n eccordanco vyith S n ,o <br /> rutrs end riQuf}bone Of ihi Sen Jo u1 aT vunly ordiriiric9i lista lows, and <br /> Homs owner or((can id i9_.rl �BWnty <br /> frnploy my parson in+ iQarll'e e(9nilurq Fertil(9e She 1o119wine: '+(gerlify;hal in3lhi perlvrmsnca 1vl tha work Iol whI<h hit♦pel{ni;l/issued, I shall not J <br /> t:arliUas the following:e l f rniY tha as to pacoma eubjevl tp workm9n'e componsilitin lows o}Califor'(i,"Contractor s hirin or ub; I <br /> "i irtil rhli In the Perlarm�nco pl the work}qr wh(sh lh�O f!il!nl!iO itaueo, i ih Il m.l0 4 a. GQmreolinp s(pnetura <br /> tion lows of Caf(fomto,•' 4 e_ P Y per n ub'aci Sp workpt}In';campansa. <br /> op.el. .l <br /> The oPPIIci st c 1Qr - quit' InfP0 ( '.' <br /> o' Cp 1019 drowinp o eYll" Old t ► s <br /> Signed Title: <br /> Fail 09PARTM91III USE ONLY },' <br /> APplicalign Arcoprad by <br /> P!1 or Grout Inspection ' Pale v. Area �'�s ► <br /> by .- <br /> Dile - Final Inspectipn by <br /> Additlonel Commerntoi i" Date ` b <br /> AAF1[caat - AoLurrt alacORL98 tos BAN JOAQUIN COUNTY PUI)LIC R = <br /> ENVIRONiIIENTAL 8 13AlrPTN fiIBRYIC88 :` F', { <br /> q ALTIi pIYIaION SRIIIT/aERYIC&f3 <br /> A48 if 9AN JOAQUIN, P 0 IiaX SRO �� r. • <br /> FEE Qr 5TWCHTON, CA b Ol C 1 <br /> INFQ AMOUNT Dug AM J <br /> QUNT nEMtrTep <br /> N AECEiveo BYt1711y1 <br /> OAT6 <br /> f EfiM1T'N0. <br />