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" <br /> SAN JOAQUIN COI�NTY PU _ICTII!D [VICES <br /> 4.35 N SAN JOAOUIN.PHONE(209)469-3420 141 b <br /> 11 0 BOX'ISS.STOCKTON.CA 95ZOI.038-9 <br /> TIJ <br /> PFILMIT EXPIRE ' I YEAR FRQW DAIE <br /> (Complete in Trlplieatp) <br /> L�)3 <br /> rlS:jjI:hc -ihi%appl-C jililr.j,mad:in cornpit2rice wir?l SAD <br /> Application is hertbv redo to San Joaquin Criuv�1,1;a 1--i:!fl c0n'!`u�l an-'0- <br /> I I -11:�_L and cure Rule,and R:gublinns of San Joaquin courim.Pu. fleaTth Services. 'S <br /> loaquirs cmnly Dcwlop.men,Title Sec:me 9.1 a,",SeLlfirn 9 C'It,c) <br /> V'r rv, <br /> Jot.Address <br /> vrrk, <br /> _�-79- <br /> phone �V. CZ, <br /> 'ess <br /> O-nsr's Name ,A A cli <br /> P"Ae <br /> Co�!iattor ruair le-i- DESTRUC on ��.out or service Veil 0 <br /> TYPE OF WELLIPUMP NEW WELL WELL AEPLAC:E?0FNT. Monitoring Well 0 <br /> PUMP INSTALLATION SYSTEM REPA!R = OTHER C; <br /> - <br /> DISTANCE TO NEAREST; SEPTIC TANK SEWER L:NES DISPOSAL FLD. PROP. LINE <br /> FOUNDATION AGRICULTURE WELL _ OTHER WELL- PITSISUPAPS <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS <br /> D's.of Wall Cooing <br /> L1 <br /> C 0 Maniacs o's of Weil E.Cs�at.on iAdusti,ol 0 Open Bottom <br /> I Domewc/Privale Gji <br /> ' val Pock* --- Tracy TNDO of cas'Ag__ Sp*czfic:slPon# <br /> 0. <br /> I'l PttbTic 1-1 Cow 1`1 Dena Oepih of G,ovi SeaJTypo of Grout <br /> ApI.Ov. Depth ! I Eastern S.risce S•.l Insulted by --PIvur-hl:r_ <br /> __ <br /> Q, Type of Pump <br /> P Stale work 044ecA Cr) <br /> Repair Work Done Sealing. haterls.1 A DePtIn LL <br /> Wall Destruction 0 well Diameter U L It LIA <br /> Depth Filler Material A Depth <br /> TYPE OF SrPTFC WORK: NEW INSTALLATION!41-REPAIRIADDITIMN i I OESTRUCT;ON I 1 "9 111,C•."Offt bhC selmw is <br /> Installation"so": Residence ComMeMW Omar <br /> Number of living units: / Number of bedrooms <br /> Character of&04 to a depth of 3 1041: 12a C42,21ii Watertable depth ;r3 <br /> e" Typo/Mro 2 f-I '-,'0C Csp&C,%y fen�cl�� NO.Ce.,pairtments <br /> SEPTIC TANK <br /> PKG.TREATMENT PLT.0 Method of DkLloasal <br /> Distance to nearest: Wee _)/M Foundation lf)-[7 Property Line >fi22 <br /> LEACHING LINE LRS No.&Length of lines 70 Total longli'llsizo 0 <br /> FILTER BED Cl Distance to neateET: Well IF ,-NO Fown-zanon S pr-o <br /> Party Line.> <br /> SEEPAGE PITS l�Doplh Z 4- Size Number <7 <br /> SUMPS L1 Distance to neartgl: Well X410' foundation > ti Property Line <br /> DISPOSAL PONDS 0 <br /> I hereby certify that I have prepared this application and;hat the work w3l be done;n accordance with San Joaquin county ordinances.state Uwe.and <br /> it rules and regulations Of the Son Joaquin county <br /> Hcw ownir Or licensed sg4nl,o jkgnajuro conift#$the following:-4 certify That in the performance o:the work for which thro perrrut is iuu*d.I WYRII not <br /> employ any parson in such manner as to boicOmit,juboc,to workman's compens4t,on lows of Califbenib."Contractors hmnq or sub-contracting signature <br /> certifies he following:"I cojily that in the pa-fafmance of the work for which this Permit is;4auad.r shall employ persons Subject to workman's Comport.to <br /> tion Paws of CsfilOrnid <br /> The applictin*must Call for all f6qui:04 incP400"s Complete draw,ng on reverse side. <br /> �7/ Title: Ditto! <br /> Signed <br /> FOR DEPARTMENT U.E ONLY <br /> T3. r—qrv,&K <br /> Dais <br /> I Areal <br /> Application Accepted by <br /> Oils <br /> FFindInspection by ---it D t <br /> Pit or Growl Inspection by <br /> Additional Comments: <br /> AppItCAnt Return all CVPlecapletto: San v <br /> Joaquil County 11t6lill ServicesEn-ireilintrital Iie;j h yemitiScrviccs <br /> 445 N.San Joaquin.P.O.Bax 388,Stockton.CA 95201.0389 <br /> FEE AMOUNT DVE AMOUNT AtAAI-,r <br /> INFO ED eAsk,,. L RECEIVED BY DATE PERMIT NO.. <br /> EH is 24 qritv.,e2 -7- <br /> S7 <br />