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SAN .JOAQUI,N I:C)1FNTY PUBLIC I''J::.L .'!EI ;;RIJV[CE5 <br /> f•3rV I=3()NIdiKNTA1, 11I:r11.'IIi D I V I:i I 11N f ' <br /> 115 y SAN .I(7AQCIY, '1110NE (204)468- 1420 �E !a w+ <br /> p .0 lto;n 2009, S-r K:KTCN, CA 95201 <br /> .1. <br /> t ItiC P1:RAiIT FRPIItFS I YI':e I;_jLIZVMDA <br /> _ <br /> J- <br /> ... 1 1-' _ r.f'.r:: ,:!: :na alt,t".0 vc.s !erre: deacri�ed. Th1a <br /> ,Arpltcwtion'is h?reby'waft to Swa rrs�u:r. C'>•.+y _ f'•_•... ,.._ .J_b2 aHC the fr:.'e■ end ilertviatSons of San <br /> v:t., Sar. v. ..•, ' �f_. .•.Y - . <br /> - appllcatSeti leeeade 'Sn torp!:nnc_ , �� c <br /> .Toaquln.Cp'lrrty Pub"'' Health $e-rrlcee. <br /> ��1� ��al(�a� rCl.�_.._:?�R�_.. _ �c!71C. �•.�q�� � �.�_Lr.l A.:r.�. ti� � Nfy. <br /> Job Address <br /> 1_ A•!.t•11s,t/11ty.� 4�!.,,._ <br /> ...: Ownat's <br /> I - ,�-;.f• /!r(J(�,)`Ff) _-L, rrsc�1:��F'_Z�__Pnar S�P� .. <br /> a�1Z— w -- <br /> t:'lit NF✓I.+CF,h'.F r,t OESTgUCi,ON C-:T,t '4 ltorlce Yell ❑ <br /> TYPE OF.WELLIPUMP .4F:•:.WELL ,: tWnitorirtg Well. C7 <br /> ' SYSTEM REPAIR � OTHER �, <br /> PUMP INSTALLATJOV :� <br /> O�-�.� PROP. LINE <br /> DISTANCE TO NEAREST: SEPTIC TANK . jF' -AGpICULTURE:yEtl - OT-ER:uELL�/�.— PITSISUMPS <br /> FOUNDATION -�-- - - - <br /> TYPEOF Wftt ?ROBIEM AREA <br /> CONSTSIUCTIDN SPECIFICATIONS i <br /> . ..INTENDED USE _ -_ ----LFM _RE .. ---".-'---� - Ou,of well Cnu'p <br /> C3 open 8n[tom Ci Manttca D.. of Wall Ewce.elr�/ - . --___ <br /> tndustnai Taae p1 l.ee np TX_�r SpecificationsyGro <br /> �,C.Grarel.Peck. ')Traci ?"."—' \ <br /> ` .Dames7rclPrwafe Tree <br /> - 1'i Other f'' Oelu' Deorn o3 f,•ow Snat of Grow 1 <br /> .. ..!'1 Public <br /> trrit)al wr• ., 2• Appro-. DbPlh ? t Eastern S' Eau Seul lnstatl,d t*r.rJf�I�•1 -a- <br /> H P. .$tate Work Done <br /> RaPair Work Dane u 7ypa of Pumv — - <br /> . Sealfm ffatert►1 i SSepth-� <br /> Watt Destruction ❑ Word D,art+elar. - Tiller lfattrSal i i?aptT. <br /> Depth <br /> - TYPE OF SEPTIC WORK' NEW INSTALLATION i I REPAIR!ADUI TION ' f+l]Tt1V[t.:JN+,' �rarlabpe'wdhn iD0 feaLfed ff n ' <br /> Insiarlat;pn will serve: RasidenGa Commercul,.__., Other <br /> Number.of Wing units: -: Number of tw]roome.�--�r <br /> _ taster table depth <br /> Characiat of rfas to a depth of 3 faaB <br /> Capacity— <br /> SEP <br /> apacitq •'+p.Comp►rtmants \'+- <br /> .SEPTIC TANK ❑ TypslMlg - Method of Di"tat <br /> ...PKG.TREATMENT PLT.0 - - - - Property Line -- <br /> ' DiatsnCe to nearest: V.est: !'l,__ Fpuodetron- <br /> LEACHING LINE. Ll No.d Length of Ines — - -- proven Lone - -- <br /> FILTER BED <br /> C 6istanca ip nearest well �___. Foundei'On Y <br /> SEEPAGE PITS 11 Depth -L-- <br /> Slze anca to Hearst[: Wen Foundat.cn- Property Lino <br /> SUMPS LI Disl <br /> DISPOSAL PONDS ❑ <br /> I hereby certify that I han-e PreOar�'this applicalron and lnat the work w,I!9e done on atcordantt w:rn San Joaquin taunts off rnances.state laws.a <br /> rules and regulations o!this San JOaQ„in Couoty this perrrook mL w06L for <br /> Ftorrm Owner or!;tamed agents ugnslure certd;as the following: <br /> %C pensation law,of.Cel fomrs.,Conlreccto s hiring or ub contact n4fa+gn+ture <br /> employ any person in such manner at to become sable . <br /> Cs rtifias[rte fOeawirtq:''I car[ify that in the performance of 1ha'+rofk for which ih!t permit a issued.I•hall employ Pa'Wne subject to workman 1 cortlponas- - <br /> lion lava of California` - - <br /> - The applicant tt tali Sot alt required in:paetions. Complete drewlnq an reverse s�os. <br /> Date: <br /> Sigrwd �s� - <br /> �- fOR DEPARTMENT USE ONLY G -1) <br /> Area r <br /> _.Dare___ �— <br /> Application Arceptad by - - <br /> . <br /> )'I n Date ZJ2 Final Ist"Clien by_ Do!a <br /> PitGross Inspoction'by - <br /> "' APpllcant rc <br /> --Return all cOPI"' to: .. <br /> Bnul raswnn[xiRe. y t•rno `1 , re, i t.'Sery fenn `�•t <br /> _ - - 45 N :ars .torula., P k, Nn[ 2009, 5lkn, I:A X5201 <br /> J K AT E <br /> - k1�t-fED 'fCfw[7 Ev D E <br /> AMOUNT FIEW", <br /> i* <br /> i rEE AMOUNT GU( - <br /> INFO <br /> JK 1344 Iary s.+Si �� .1/�.v 11 �c� .' F � 50 <br /> [w <br /> 14 In - <br /> _-..1 <br /> Ik ; <br /> I <br />