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• 'ib r it <br /> �{1IFN��n <br /> 11w�s�a <br /> NO81AN] <br /> APPLICATION <br /> MYTRaRACMAL RRAI '8 DivisIQN <br /> 445 N S" JOAQUIN, PHONE (209)468-3420 <br /> kEzAtP 0 WZ 2009, S TON, CA 95201.l Xd <br /> ATS ISA i <br /> (Complete in Triplicate) <br /> Applica.ttcn is hertty m 4*,to Sr.a i squia County zar a pers=t to conetruav atWor L:ey the worx.berefn aesrriltsat. T»I <br /> applicatttan 1st arts 14 Ca*aL&t,em w1tob San .i<04444 Cowrtty Ordittaat:e 114. 5L9 sad 1862 ttad the Aute$ a" Rtiyt2+tioai rmw <br /> J gaits Cnnaty Public Xe*lth 8ar4ccs. <br /> Job Adds. �` M . I�-R City S r -fJrl Lot Size/AcroW <br /> j �wt1E+ arca d.J f°..,,� ddem 1-"s...�,�..!c.. J C 9 F <br /> 'a N C .� 1r.s�__t1.L8 A �-,��,,,, _�5�c � phone <br /> F rrr I <br /> Cunfra,cltx �.r..c.L 1. ,44�t A- Address is �eC1YSCftC.6C.770:+' P110ftE.(11&R��st��� <br /> TYPE OF WELLIPUMP-r - NEW WELL Z; WtLL REPLACEMENT L i DESTPUCTION 0 deal cat rv1c* Weil C <br /> fyt,MP FNSIALLAT)ON r: SYSTEM AEPAtR C? OTHER �s.:r i'I Vt�.l C <br /> Y1 '- <br /> NSTANCE TD NEAREST: SEPTIC TA14K SEWER LINES DISPOSAL FLD PAOP. uiq I� Y <br /> FOUNDATIDN ---_-- - AGRICULTURE WELL _---.--- OTHER WELL PITS/SUMPS !G r <br /> INTENDED uSE TYK OF WELL PROMM AREA CONSTRUCTION SPECIACATIONS 4 ` <br /> 1,;irtd+lstrte� 0 Open 9ana!n n MI:lntecir Ghia. tyf WAA EXCAr46drk _ - Sia. 4f VON Cmiscq <br /> t.1 00+1wiciptivale O avaf Psc4c ❑ Tracy Type of CaeiN_ 5pettiTicaila,*a _. <br /> Il PuhGt 1'(biter r Delta Depth of&.1 Seal type of✓;Iron!_ r O <br /> L i trr,gatgn ,...Aaatra,. DWIh I 1 Emtern Swfat.e Seat iniritled by-- -C <br /> flepair VYcwk Done L' Type of Pump !f_P_ State wwk Done -- - — .1~"Y•',�W <br /> Well Daatrmi4-1 u won Olatramv+ Sbt3ldng Itaterial i Dtisth <br /> pepm riper 1iatarial s Depth <br /> YPE OF SEPTrC WORK: NEW INSTALLATION i REPAIR-FADDITIO14 t I DESTRUCTION [i RUO SOP=it 4V2te ►pwr itmd it p.Mcl' r q <br /> aveilaWe rrrttim2w fasl•I <br /> InOct$400n wk11 fierya: A0.0ftnCe.— Cal+rrterCiat— Other ..,,..,.�...,..r <br /> N,rmbw of menti Unita: Number of bwIroorlic <br /> Chartetse of ZDA-o a twpth of 3 teas;: Wstu nhae <br /> SEPTIC TANK E3 T 1 9 <br /> N4 <br /> n <br /> YAe _ C�pdCItV� _ Ccrrlysertrrlsrrts <br /> PKK. TREATMENT PLT Ct Method NDAPOW <br /> Distartca to twtrast: Well Foundation- ,,-�,.. Ptapertr Lift <br /> LWHINC, tjkf D No,8 Lanoth of lines Total Ianpthfslte_ <br /> FILTER SEE Cx 0imnpa to niureat: Well � Founom an -- -- Property Lina <br /> SMAGf PITS i I otetutx Sus _ Numbs! <br /> SUMPS LI UstAnce to nmrau: well Lira <br /> DISPOSAL PONDS Q <br /> I Halals?E&Rity Mat t I&M pttipared rises,aupka6mrs and that IN work wit bae dace ie oecordance with San Joaqukt county Ord4laneW lta jaws, ti <br /> r rules and rpr he fi%k4cipak s $an J4aAttln Ctflitlty lh <br /> i IOrxta owner(w Ikens"aprtt'a ii4natwo cowmits the lottowinQ; "(cartlfy that at rho Pe+igrmsna&of the►Yvetc fres wMielt=his Pamit+4 igpisQ,I,true r <br /> *Moloy any Person in turfs rrsearseir es to bAMme fyhfptt 149%**Fneri s oompsnaetian Laws of Cawmnia--'Cottli4tors hk tlQ of s,tfk-t:Qtlfrtt&wQ Vprstltt <br /> ebftiftss the foxowing.•I CMrtifyr!hat in the Attrwnww Os of the work for wrc3rh 11116 Rtt'l*a1 is ittrwed,I*W OMNI"#tt SMA SUIU Ct to rr0rkrn&6'5 cocr*wmi <br /> bass la"of Comma. <br /> Tho appA c au aired ins* CH4ess. Cutrpiees Aravrvrq an rearwm%;de. � <br /> A + <br /> SiBc>� True' �f 13�x•s 7" _--T_ Gate- -- �2.�'if9� <br /> FOR OEPARTMENT t$SE OJILY J� <br /> Rpplicetipn Acasptee by Fits 7- 7—�3 Arse <br /> Art of Grout Irxpsetiorr by C pitta /�� F3tia!lrytpettidrt Date / <br /> AQditional Cttrnntillltit; ✓ r40tt <br /> l� <br /> f Afsplic*tt - aetuM -a11 copies to. San Joaquin Cats Publie ficllth &L-rv#c08 <br /> I $nvAr—rtv*L1 L YCshiilServ�GetY `� <br /> 443 N out Joaquin, P 0 Box.2009, SLlrn, CA 95201 <br /> INT flt1EAk1QUllT RlgdilTTEfl CK RECUIVED BY DATE l+fRMR'No,�21 <br /> � <br /> +� Li <br />