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APPLICATION FOR PERMI'i
<br /> SAN JOAQUIN COUNTY PUBLIC HP'--B SSRVICES
<br /> ENVIR0XIIENTAL EHALTH D SION
<br /> 1 445 N SAN JUAQUIN, PHONE (2M)4O8-3420
<br /> P O HOE 2009, STOCKT0N, CA 95201
<br /> - y$RUIT IEYDIRB4 1 '($AR PR0P_"'t3., I,gSU2
<br /> ! (Complete In Triplicate)
<br /> j Am ltatlm to Noy Rade to Sen Jaa4ut. CouOty for a Farah to ton.truet AN/er lmitell the wo.Y hereto dee1116ed. T.11
<br /> ! tCgl3eAtlea t. ae,d• le eolplluw. with Sea Jo uin County Ordloanc. No. 549 " 18U AOC the p91t4 Aad R.Aul A4lm. of lAn
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<br /> Ij TYPE OF WELL/PUMP' WLW W-LL U WELL REPtnCEMFNi Cl DESTRUCTION Ll out of S.rwtu V.
<br /> PUMP INSTALUTION ❑ SYSTEM REPAIR J OTNE11 ❑ IUeltorlm bL ❑
<br /> t `y�. DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES __ DISPOSAL FLO— PROP. LINE
<br /> 1 FOUNDATON ___ ACRICULTURE WELL _ OTHER WELL PITS/SUMPS
<br /> INTENDED USE
<br /> rfK OF WELL PAOSLEM AREA CUNSTRUCTION SPECIFICATIONS
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<br /> Data: Rj
<br /> FOR DEPARTMENT UOE ONLY
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