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SAN QUIN COUNTY PUBLIC HEALTH S'�~ICSS
<br /> RONMENTAL HEALTH D I'V I S I C
<br /> 16ft E," NAZELTON AVE.,`; PHONE (209)468-9420
<br /> P O 13 .2008; , STOC&TON;,,CA 9520 . APR 1 3 1993
<br /> r•=t' R1tiiT SXPIRS861 .Y rLSegtaJM. ENVlRONMENT,4LHEALTFI
<br /> r (Complete .iia. Ti3iplictLte) PERMIT/SERVICES
<br /> I CES
<br /> Appiication is hereby labile tC Bad Jod$uitt County !'or h beiniiit to construct and/or i:iattil the vprlc herein described. This
<br /> epplicatien i• atede'i6 ecm�lfi�itcis,Vith am Joattuin Couhty' Oidindnes #m. .540 aid 1862 end"the Rules said fte&iAtione of San -
<br /> Joaquin Coantr Publit Hee.lth Bervicea' " ". 4 :6�
<br /> / S'. L. j a, City-
<br /> i's
<br /> ity �L1L� lio _ Wt site%Atreage '1r4 C'RE
<br /> Job Address ,�,,`
<br /> b6w C0141P Addristt.l , La' hone �• �
<br /> Owner(• Name -�,, � y.�, 1- Pjx•-,, +� Ise- l; a. , S
<br /> , O
<br /> BO 3 license Wd- Iii ph8ne 7755
<br /> 70
<br /> Contractor i A C AddreiS Q.
<br /> LI
<br /> TYPE OF WELL/PUMP::q NEW WELL x,WELL REPLACEMENT U DESTRUCTION tAit of Service well
<br /> II ` �� ``�x idonitorinS bell
<br /> PIJMF INSTALLAT�IO�NSYS
<br /> �O , .� TIA ft AIR d DT " EIi
<br /> DISTANCE To NEAREST SEPTIC TAkK �
<br /> d1�:_.:: SEIiVEfi LINE5`^ DISPOSAL FLD... PROP. LINE
<br /> iFpUNDAtIf1N- .- _- _ "AGAICULTlJhg.W LL .s C IiEh WELL' JPITSl5UMP5
<br /> INTENDED USE ,,1! TYPE 13F WELL 1;: PftOBLt=M AREA 66NSTRUttloN SPECIFICATIONS
<br /> C7 Industrial 0 Open Bottom 0 Mintets 11 Dia. of W61 EXca.e ion. �?ia of Wen Casing '
<br /> fl DomesticlPri+rats E; `� 0 Gravel Pick",-'-,, © Tracy s; Type of e�bsirig d Spetdiaationi" "' O
<br /> E ,�1 ^s 3? bf Gr qui&Ag( s ,
<br /> II Fabric `Fi yrs Other ° "< " h Delta c: Depth of Gtoui Seal Aypa Q �R
<br /> fS,��/ ox.`booth t I Eiitern Sod ca Seal Instilled by f
<br /> I I I Irrigation L "iFl1C Aopr
<br /> if# Stats Work Dans
<br /> Repair Work Don6 L7��� Type of Puri►p ,. � H.P. - `
<br /> Well Destructlon W611 DI6r»ettlr 3saling It{iteril A Depth
<br /> 5 iF� Depth tiller Wteriisi. i depth
<br /> II;
<br /> TYPE OF SEPTIC WORK: NEW INSTA"TION.I:I REPAIR/ADDITION JA DESTRUCTION I i 1N septic system permitted.f public sewer is
<br /> .. a" available wdhirt-2OO feet.}
<br /> Installation wig servi:I,hosidincs Comm6rciil Other
<br /> Number of pvinq unii;ic-,_ Number of bedroom>3 g `
<br /> P ar TANK. �rfeplh of fsett " W6ter table depth "
<br /> Charseter of rail to_i�
<br /> SE e° j❑ TypelMfg Capai:lty�..:....�.�- " No. Compartrrienti
<br /> PKG. TREATMENT PLT L-t' Method of pisposal
<br /> z
<br /> i Distance ie hear6at: 1Nell +Foundatlbn _. Property Line
<br /> LEACHING LINE E❑ No, & Length of lines Total length/size- 4
<br /> FILTER BED :'O bisiince to hditist: Well Foundation_ Property Lina
<br /> SEEPAGE PITS " E.,I I booth �.' Si:e �lumti6r. t
<br /> SUMPS ii,Ll Distance to nearest: Welt Four►datidn Property LIn'e vl }
<br /> DISPOSAL PONDS s`N; : 17 r 1
<br /> I hereby Certify that I hlvs prepared this application and that the work will Iia done in accordance with San.foaquin county brdinancei, stele laws, and
<br /> rules and regulations of th8 Sin Joaquin Couotr- Y. 1
<br /> Horr►a owner or ficensatf'agent's signature testi}res the following; 41 certify that in the pArfb+mencs of the work for whish this permit K issued, I shell not
<br /> employ any parson ifs such n►anner as to become subject to workmen's compeheatidn taws of Californi6."Contractor't hiring or sub-tbntiseting signstura
<br /> certifies the follbwingt'I certify Chit in thi performance of the work for which'this p6rmlt is tstlusd,I ihall employ perepnti lubjici is workman's compenaa
<br /> tion laws of California,.',,I ,, f .,.e
<br /> _
<br /> The applicant t c ! sof ulred inspabtions. Complete ifrawing on reveritb side. p
<br /> SignAd TiHa, A I" Date: ��� f� z•—
<br /> VV
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<br /> FOFi EPAfktM6T' U5E ONLY s
<br /> Application Actepted lay s^ °.. ;- i' �aie Area a ]
<br /> s
<br /> D '.F
<br /> Pit of Grout In�RSatian t1y
<br /> e inll Inspec on esy. - :�••�••.��-mak
<br /> . r
<br /> Additional Cornrr>dnt=::�
<br /> 9 Y
<br /> Appiicaat - met urti fill 66pi6i tbi Seat .fosgi 0 County pubii6 iieaitlt
<br /> n Seririeei� $tYlrbttisetstsl_Hleltfi t'i;2tsit�SbrviCC 2110
<br /> • � 1601 S. gak6iton A46:; "P O'Bcii 2009, Stockton, CA 95201
<br /> iNfO; �, ' AMOUNT DUt AMOUNT AIMiTTEo CASMI AlctiVEI) BY BATE PERM Il'NO.,
<br /> • Err 1344 IAM it P,So 2121Q ..
<br /> EM 3�•7a `
<br /> .. :.. .. -:'.k;p i ..•.rte. M.., ..r -4._.�. ..:.rn...... .. —.y .L: lJ - _ - _-
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