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<br /> V
<br /> T APPLICATION
<br /> �,t3 1633 . .
<br /> SAN JOAQUIN COUNTY PUBLIC IIEALTB SERVICES�Z ,
<br /> ENVIRONMENTAL IIEALTII DIVISIONL) � ✓�
<br /> 1 446 N SAN JOAQUIN, PHONE (209)468-5920 ')
<br /> P 0 BOX 2009, STOCKTON, CA 95201
<br /> PF'IINIT I'XP[RI•'S I 'l EAR YRQ�1i4T': ISSUED '�� 3yy3
<br /> ((:orRPlUt.0 In 'L•rlPliDatU)
<br /> Application L nereDy Aside to nod Jawgnin County for w PefaR to conn tract nn.li or Snetall the vprR Derain deecrt bd
<br /> e . This
<br /> aypllention 1. nage In coaplfan a with Orin Joaynln C�..ty Vrdlneoce Ko. :49 nal 1862 and the Rule- apo Awluletledo of Sen
<br /> Jpululn County Public benith 0111teeb. yrp x Y�f
<br /> Lot Yl.r/Acreme
<br /> Job Addtest � le���l�a•;td N_�:D. .-- ._. -_ ,.,,. !•At n/As1/' l
<br /> $ i
<br /> -_ Andrus �IO^;.u.. vnona _-
<br /> Ownbh Name �( . 5%'�•1 � _. ._ __.__.__.____----
<br /> ,r:✓ .� ,r
<br /> r dross _7Ar..4Pa:'LL1LR7.-Qru:- Leena•he.}ttH1L-Phone Via• - 7/
<br /> Ccula<ta G[Q.fJa L A,-tat.---
<br /> TYPE Of W1LLiPUMp NEW WELL .. WELL 11 E PLA CEh1MT 1 DESTRUCTION O Put Of 9ervlee bell
<br /> OTHER G M,w1wrim, well G
<br /> PUMP INSTALLATION ;] SYSTEM REPAIR
<br /> DISTANCE TO NEAREST: SEPTIC TANK _ SEWER LINES —_____ OTHER W LLD—
<br /> PROP. LINE _�-
<br /> FOUNDATION ___ Af PICULTURE WELL ___ OTHER WELL PITSISUMPS _
<br /> INTENDED USE TYFt OF WELL PROBLEM AREA CONSTRUCTWN SPECIFICATIONS DN.of Well C•-irp
<br /> (l Indutlml G Owen Babom Cl Maniac, Die.of Well E....and"
<br /> irm of Casing-__.._ SpecdkapoN
<br /> (I Pobtic/Prrvw L1 Or", Pact L1 Track TYpa of Gro.d
<br /> 1 1 p,�K I t OINr I 1 Oelu Depth of Glnw Seal ___
<br /> I brnlnlon APMot_ D-Plh I East., Suds.Sam :�bulled by. uv
<br /> naps,Work Done Ir] TYp•of Pump 4,P. _ ..—._— Slats l'Jork Done_ R�
<br /> :es11nK Materiel A Depth U4\
<br /> Well 06110.00A Wan Dlamamr
<br /> Depen Filler Material A Depth
<br /> y TYPE OF SEPTIC WORK. NEW INSTALLA110N PinAlfl!A UU1T6)N JE UF.STItUCT1UN 1 Available No l, d II pObiK anwer wnln 7W 1.2.1 n
<br /> Installation writ sei Reaiden,@— LING.ive.41 1-101he,
<br /> Number of kwng urns:__ Number of b„roams_—
<br /> r Tti,7 Water table depth
<br /> Character of wit to•Depth of 7 leve ”— Z No.DanFlnman0 L
<br /> SEPTIC TANK G Type/Mfg _ L-- C•PACIIY—S'- —
<br /> Method of Disposal —
<br /> PKG.TREATMENT PLT.G Zp
<br /> Dlal•nca to..serest. Wall Foundation 1P Property Lim
<br /> Total lang
<br /> LEACHING LINE No. G LwgID oI Imes —.�.- /Op r opert '
<br /> y e
<br /> FILTER BED n Distance 10 nwrnc WallN/il_ FoundHlon Hn' ProPropertyLula
<br /> �w
<br /> SEEPAGE PITS 11 poPm ---51e" f -�L Num W:
<br /> 7-
<br /> SUMPS
<br /> SUIdPS I�( Disuuca m hare..: WNI
<br /> ✓/A Foundation IPL' Proper Lina
<br /> DISPOSAL PONDS Cl d lows d
<br /> 1 ha.b,can't,that 1 Nva plop..,,in.,•poficalten and In"Ih.work wAl be dote I Accordance $ J R Y
<br /> rules and regulations of rho S•^Jo.Ruln Count'
<br /> ly t
<br /> Itom•owner w ac.ma i agent's-ig,wun,cand!as the 1,3owing:"I camhat m Ue perlo:menea ultra work for which his potent b iuued.1 aM —1
<br /> sublect to wortm-n"b companubo^law.of udwnn."Contra,,,,,,hiring or suPcontraednb signature
<br /> •molar any Perron in both manner ea w Ntoms mca al the work for which this permit If ia.ued,1.hell emVloY M,wn-wbpat w workm+n'a eompanu
<br /> condlea the following:')cern,,ANT in IN Perform
<br /> r tion lawn of Celdornla."
<br /> The applicant must CAN for Aa.purred inwahl,,na. Compleu d,.,.g on..veru side.
<br /> .n;.: (// z`. _- Date:
<br /> FOR DEPARTMENT USE ONLY
<br /> Due B-EI- 93Are• /
<br /> Applicatron Accaplod br / 93
<br /> PR w Grout Inspection In, —
<br /> Date Final In.pochen by — owe
<br /> Addnionbl Cwnmorla:
<br /> ealth
<br /> April tv not - NCl11rn It coni... to: Environmentaln „
<br /> Ya.lthr
<br /> Pemf6/Rervlrenvlece
<br /> 44% h Fan .InaRuln• T 0 on. 2009• Etta. CA 952U1
<br /> AMOUNT nEMri'rf0 N ` RECIPWO at' PATE PERMIT W.
<br /> -�rJ`1 INTO a`MUbNt DUE S4_
<br /> l , lar
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