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APPLICATION FOR PERMIT <br /> SAN JOAQU,*.N COUNTY PLIrLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISICW <br /> vY 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P 0 301 2009, STOCKTON, CA 952.01 <br /> p PERMIT IC,YIRE'S 1 yKA/t PRC11' DdTE ISSC%f_ <br /> a (Complete in Triplicate) <br /> ApPllootloo 1. t.rety •able tq San Josquto County Tm- a pt,ralt to corl a or Iratall the work Perrin described. STI* <br /> application to Wad. !n Cca llante with Sen Juequln County Ordinance No. 549 amt i?:.' And the Ruler led Pe3uLtionr of Baer <br /> f Jraqule f'.u,.ty Pub11t 11411th Servicer. <br /> JOD Atldroes _�_QO 1N- BanAol Road 'C:!Y-_IaC!!�_— Lot 91 se/Acreage <br /> 7 <br /> ' Ow,e/1 Name Harvey Properties 1s,tdddr.t. 4400 E. Handel lid..__ Phan 2Q2-AZ5953!_ <br /> Con!u Ua Add,nt license No. PMpe <br /> I TYPE OF WELL/!'UMP: NEW WELL 0 WELL REPLACEMENT n DESTRUCTION CI Out of Banlea Wall <br /> -- psoni tesla{ Vali <br /> PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER ❑ ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES _ DISPOSAL FLO._ PROP.LINE <br /> Y" FOUNDATION AGRICULTURE o'FLL __ OTHER WELL PITS/SUMPS _ <br /> d, INTENDED USE TYPE OF WELL PROBLEM AftEA CONSTRUCTION SPECIFICATIONS <br /> ❑IMustnps ❑Open Bgnan O Mamoce Dia, o1 well Evuvuion Dy.of Wad Coati <br /> O Domeanc/prkuk ❑Groups Pack Li fifty Type of Casing_ _ SpeG!icatipre— <br /> `' 11 Pub1k ❑Dilute (i nea. Doom of Grout Seal Type of Groin_ <br /> 4 <br /> 11 Inigalbn _—Appoa. D.pth ! I Eastern Suet.Sox!Insul4tl by <br /> Raw Work Dope U Tvvo of Pump H.P. S1.nl Work Dora_ <br /> WON OMrvctkm O Was Dbrvetn 8e111nB Nater1&1 E Depth <br /> Sk <br /> Depth Pillar Material E Depth <br /> TYPE Cr SEPTIC WORK. NEW 01STALLA7.ION 1 I REPAIP./ADDITION I I DESTRUCTION I I IN. P,lc system pos,"Ped A Public www is <br /> !A aYalfaNIC within 200 I041.1 <br /> ehettAinks,will wrw: floxm ce_ ComrarcW_ Other _ <br /> Nun. of!lying units:_ Number of Vaeoms <br /> 0 Dba,l t.01 Pea In a depth of T fest:_ Water!able depth <br /> SEPTIC TANK ❑ Typo/Delp Goaciry No. Ganyrinenb <br /> PKG. TREATMENT PLT.❑ IAathod of Diepotal <br /> DlatAncl to few: Well Foundnion Property Line <br /> y LEACHING LINE 0 No.S Length of liner _ _ Torol length/she__ 4 p <br /> I <br /> FILTER BED 0 Diatance to nearest: Wel'__. Foundnan__ Pr pasty Lye - <br /> d SEEPAGE PITS 11 Depth _ S»___ Number <br /> �. SUMPS LI Oipsarxe b rruesL Wait FouMotion Finn"Lina <br /> DISPOSAL PONOS 0 <br /> I hereby oli thol 1 bare pek uad this.pplicatfon end that tM work willW done in Accordance win Son Joaquin county ordinarti ebb sweet.and <br /> rule;AM Crouli l'4M of The San Joaobn County S <br /> 01 to ower 7t litawltl apron egnaturo wedium:M loan g'"I cors N tlet in tM xaCormaneo of the work Ia vAkh[Nm pun5t is eauW,I"not 1 <br /> A"Ali perbon lin such meow M to bocearo subject IC pro linen i compensation lows of California."Confectbr-1 haI or WRCgnnae1k10 SoVkrro n <br /> Contains,This,lobwirp:"1 certRy that in tNe W omenta of the work for which this perms is eautS,I shall ampbn <br /> y poonaged a rto workan <br /> m 's valrlpa,ei� ! <br /> tion was of Cawori i i <br /> The shookont moot$$0[OK&OV roqukod x Vr lone.Compete drow'mg on rove,"lido. )1 <br /> r. SW4d /_ -�.�c! Tltlr-Parr r Date: <br /> d ARTMENT UDE OHLII - S <br /> o- <br /> w, Appfcltkan A<esptM by �iZF_%„4 Z' I/ Data I A —^T2 Art• <br /> f Pita Dian Impaetien by Do'* ss <br /> e al lfcrron by Om 1-44 <br /> 4 f <br /> Adadael Cgmrwlb: _ <br /> M <br /> K'1 Appl icartt - Return •1]urn ..pis. R.1 Jo4gela Count) DuPont H.Altb <br /> a �N4\�a <br /> NovlenWnml Health Parelt/31rylevil <br /> ceN Sort Joegliri '\ <br /> ' <br /> P 0 F�a—t-•T—OOPS, Pate, OA BNTOI <br /> rr /t! AMOUNT W4 AMOUMi Pl M1TTe0 CA H I aECEIVEO W �CjAT{Sy Y:PMIT ND. <br />