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<br /> APPLICATION FOR PERMIT, F r s f zyf
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<br /> SAN'JOAQUIN C0UNTYrPU19LIC HEALTH SERVICES 11x
<br /> ENVIR0RMTAL'HEALTH DIVISION
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<br /> Lq.J V nr .` pxR11IT BXPIRS3 1: YEAR If&QM`D�s IS$USD
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<br /> 1leation.iaorreblr aads;W Bao"Joaquin CouotY for a•pereut.to eone
<br /> truct aao/or Install thio wrk herelo'dncrlbW Tbia y .c y�
<br /> appucati",le stade.;la cmpllaete,'rith Ban JotQuia tountyhOr43naace Ito S4F and,1156C and'tbe Rules and 1lejrtlatiaoa`.oftBau
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<br /> WELL REPLACEMENT 0 r ;DESTRUCTION Q Out:or'serrlce,Wall<clsP C"'. "/•l ��
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<br /> PUMP - {4'? �' � 4.n
<br /> �fDISTANCE"Tp'NEAREST SEPTIC 7AHK " SEWER LINES � 0O5AL FLp 'PROP LINE,QiL
<br /> _,`�ic�r�k�'r�'}' fpUNpATION AGRICVLTURE.WELL- OTHER WELL'`'
<br /> INT1 NDED USB;r "t TYPE'OF WELL'kaPRONLEM AREA t0N5TRUCTION SPECIFICATIONS
<br /> !�tntltfstriN' 'LQ 'Bottom Q Manuca Oia of WON Esayslion Dia°01 Was C�wlg $' �'
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<br /> y1 atpn; 1 ° ApporE OsPth �jEaston 9urfsea Swl inataUed by_: — r
<br /> R LU T yot �:LeS� H.P. $uu Worn pones a -ty " `* riy� �
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<br /> i E EI I WORK: f'fW INSTALiATIDN 0, REPAIR IAD01TI0N Cl. DESTRUCTION Cl !ho septic system Par tied it public sewer
<br /> iawitable within 200 feet-1, A
<br /> rtitaBMranyvsM flats it;RMidrnoe G Y COfnmercW...'. 'Other - s -5P i r•r i '�'R `"�' 'Y' y Xi
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<br /> S1"IC TANx ` ' :fl rypNMry CCwciTr No.COMP&MR"ts
<br /> PKQTREATMENT PLT ❑ ,..,: Method 01 Disposal
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<br /> LEACHING L�NE�� Ll No f�length of linea Toul length/six � �t t � `�,r y�,
<br /> iILTLR QED fl C,stMa to nelreel: Watt Foundation Pfopeny Lina
<br /> 1jsumal rlTSurt "°I I,,-Depth .. 5in Number
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<br /> $jJM►>i �`LI Dfstaflca W naval: Wstl Foundation Property Lute
<br /> �. Dis►oSAt FUNDS �a',"q
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<br /> �.hMlby'deniM I11.1 he"prepared mis application and that IM work Will W done in accordance with San Joaquin County ordinit"e{ state 4Wa and'1} .4 , r4E;r "!
<br /> 'We'antl fogulalwns•o1 the San Joequln County
<br /> HOCM ownal, f k~apMt'a signature a.r.,tas the following:"!cagily that in the performance of the work tar WttCh this permil is issued,.I she Ml'" lY
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<br /> as 10 become breet ID waikmari a compensation laws of California. Contractor's hiring
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<br /> caro"thio IOMowinp I Comity Chet in the 17ormancs of the work for wxvcri this oernut is isaued,i shall employ Persona subject t0 workman S GOrTv�erij's.
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<br /> TM Itpplkanl e M required Ninrpelelions.Complete of wing M reverse s�da. %;
<br /> Sigrni7 i !i .l - - Title: "CJS-- Dao, N.
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<br /> A 'SAX JOAQUIN. P-0 BO 2000, BTUCKTON. CA 95201:;:
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