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P <br /> APPLICATION POLI PERMIT <br /> ;.:AN J'OAQUIN COUNTY PUBLIC H".ALTH SERVICES <br /> 1,NVIRONMENTAL HEALTH DIVISION , <br /> 1601 E. HA'I.RLTON AVE. , PuONE (209)468-3430 <br /> P tJ BOX 2009, STOCRTON, CA 95201 <br /> (Complete in TripliCste) 1 <br /> A;rllcntiDn is hereby itade to Can ,:anquLn County for a peraft to construct and/or irtata2l the cork berets deaeribed: 'MIa <br />' Rppliretion Is rmde in cumlianc• with San Joagw, County Ordinance No. 549 and 1862 and tht Pulls ad P*901,6tteas o!Bab <br /> :oaqul� County Public Health Services. <br /> . !ou AdQleE5 ',7 C % / - City L <br /> A2,,g <br /> << <br /> .,� <br /> awnerr Nrme ddrnrr � <br /> ee res <br /> t <br /> ry=E Cf WELL%P+JMP: NEW WELL 0 WELL REPLACEMENT C1 DES7RUCTION ❑Out at S4r104 -11-1,. <br /> PUMP INSTALLATION 0 SYSTEM REPAIR f7 OTHER n <br /> lloeitoring 161.1 <br /> C3 <br /> nISTANCE TO NEAREST: SEPTIC TANK SEWER LINES — DISPOSAL LLD. PROP.LINE <3 <br /> FOUNDATION AGRICULTVAE WELL......, OTHER WELL _ ftITElSUfvtPB Y <br /> 4"-;:., <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS F <br /> i Industrial Cl Own Bottom 0 Manteca No,of Wall Excarstion.,- -- DI*.of VKM 6sslnp. y <br /> DomeuiciPrivate Cl Gravel Pack 11 Tracy Type of Casingatoull- <br /> . -- l3paalieatfons- '. <br /> I'i Puhtic I.1 Other it Delta Depth of Grout Spl d <br /> i i Ir�i(ptrOn Amwoa. Depth I I Eastern Surface Sart Invased by <br /> Raphe Work Done U Type of Pump H.P. Staf!wak Dent s' <br /> Wets Ltestructioo 0 WeH Diametsr mai Mkterial i 019th <br /> Depth Tiller ilateiial <br /> I vPE OF SEPTIC WORK. NEW INSTALLATION i I REPAIRlADDITION fp- DESTRUCTION I I INP sepfkc svgwn psF+rMtad M pubMO www isf <br /> vaxbal . <br /> asble wMM ICO d rt <br /> Installation wti serve: R/s7cme V Commercial— Other p <br /> Number of fivin9 units: t� Number of rooms i LL <br /> Character of soa to a depth of 1 feat: Vllnsr ts01s <br /> SEPTIC TANK P"T"/Mfg coo tt 16 @2- 'lib.can6wwtitww 2.mia a <br /> i, PKG_TREATMENT PLT.Clst�� � � sad at� <br /> Distance to nearest: Wo1QSG . fokRldation_ardSrL_ Prope tr lin 3e0', F <br /> LEACHING LINE L'f'�No.d tength of lines r'- tow IAIVh11 �,�r k <br /> FILTER BED C1 Dletance Io n"MU Went 7Q Founwatfa► �tc _ ProPsn Llrt*^sem-I <br /> e <br /> SEEPAGE PITS 4--owth <br /> SUMPS LI Obunce to nsanrr WeN/� f.. FeltltQatloA.�.�Q. . ProOift Lin*.s" . <br /> DISPOSAL PONDS f] i <br /> I hereby candy that r hive pretnted this appkir ian Md rhat"w w&k wit{bs deft In allWdo.0 wkh Salt JONMM COt"AW brdfISIrIC ,festa tttlArf. <br /> rules and ngulefiOna of the San JOagwfn County <br /> Home owner at licensed agent's sipnalure Cart,(*%the}*Mowing:'9 f: '0V that M ft PWNM* t:a Of do"Wit for tNAkh&A ON!i is wined,F ghat ltot �# � <br /> employ env person in such manner es to become auhMet to workma►'s COM0*0nRion bvas M GNlornia."Cdntrgetar'i MrIhO at"ContraelinO tdO Wwo <br /> tsnifiea the fotioWng:"I tenfly that in the performence of ttx work for vA* this psmW If issued,f allyl irtlplsV IratlOrta sitbjaet to slrOiArrift►'a CbrflparMF t <br /> tion laws of Calif*mla." <br /> ` The opplont must all for ale Pall apKtionr:Compiaa dra"V4 ort rever"aids <br /> Signed tr.o�. . rule: ; <br /> _ Fbtl DEPARTIIAENT USE ONLY ''] <br /> Applitation Accepted by � C_ — - OM �r Am <br /> �j or Orout Inspection by t4 Data yc`/ FhW Ifopattkn bV <br /> Additional Commenta: <br /> Applicant - Peturn all capias tat flan JoRquin County Public Realth <br /> Services. IKaviroumental Rmlth Peratt/Ba"I es s <br /> 1601 E. natelton A"., P 0 box 2009, Btecktaa. CIL 9SM <br /> AMOUNT DUE AMOUNT r1EMFTTBD •fel REtf fy DATI P[RWI-No. <br /> ;Ftt <br /> .FO <br /> Iw 1124 KV -4 / y. ~` %- • d�� - RT( U� / - � a <br /> .. - .. _ . ..�« •...,..yes,.,,: ;..._.As <br /> 4 <br /> 1 �F� <br />