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<br /> DATE MLIV)
<br /> jJ ,' the p' -J t to construct and,ar install the work herein t
<br /> IAbnlicatfon ,s ncracv :ade to San Joaau:n focal i+.•al••' r.;_rYc: ,r a i r
<br /> 1CCtcriOed, This apviicat,a� "Ade in r'3:�alianca x:tr.. %an 'nnl,:" I•,unt'. :'rJinancf No. 549 fcr sewage or No. IS62 for hell/pump
<br /> end the Rules and G'egulati`nnc of the San -joaa;!ir,(LLac.,1
<br /> J0 Address (,l li i _1!/_C� :Cly 1 _ Vii-'gym #_ 4 ��• l'_ -?-
<br /> + :I fp3'
<br /> Phone Name • ...... fy-
<br /> tontrattor'S Name
<br /> Phone
<br /> TYPE Of HELL/PUMP WOR`.' 3i `IV WILL 1.�1 ♦CLC r7ErL:: {'!E':' i_. ^EST UCi{Oti i�r ga A•cn,�•y-
<br /> 'i
<br /> cUNt INSTALLATiOti j�i S`%TLM AFFAIR OTHER _}
<br /> 7 DISTANCE TO NEAREST: SE'TiC 1A'71; -0 SE6.R LINLS DISPOSAL FLO. PROP. LINE ,
<br /> FO'';•i[1dT10'i _--- Af,fKULT_[nE WELt, OTHER .-.'uL_- PiTS/SUMPS -
<br /> -
<br /> INTql
<br /> ENDED USE a v.^L Or 'nELL rAOBIE"' ^•c"td f
<br /> R,C:i^'7 ;�Lcrrtcn'cn:5 y �
<br /> F] [itdustria! U Open Bottor Mahteca ^ilia. of Well Excavation -�.17Y A
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<br /> DpmeStiClPrivdte [XGravel Pack Tracy :'r 3. of Well Casing
<br /> Publ4ci Ca.Other Delta ! _
<br /> LJ LJ ne v
<br /> ;i l..J Irrigation _ 'i -- Aoproti. Lj Easte+'n S,rc'rificatio,.3 m ��- �'
<br /> Gathptlic Prpteon ctiDepth
<br /> i f i+Lh G` Grout Seal __ ~
<br /> Geophysical iv.-:o nc Grout
<br /> ! (Other Sur!aCn SEdI Installed b
<br /> Repair Worn, Done Fj Tyoe of, Pc,mp -.,�y�.�.-,. M.1'. _ ___...- State Work Dona
<br /> I Well Destruction jWolI Diameter4 '� Sealing Material (ton 5'w'
<br /> I f U hllJ �ti"l__ filler Material (f'+Inw 50
<br /> TYPE GT SEPTIC WORK: NNW INSTALLATIO; i,I REvAIRl�DOIT1n% acvk i; tanr- Or seep •'m
<br /> a9e Pit peitted if public sewer 15
<br /> - � --—- � - available within 2D0 feet.}
<br /> Cormercia
<br /> Installation will serve: =Rf..,idence l Otnvr
<br /> i Number of living units: Number of bedrooms __-__ .et s;t•' _r_.__-_Y_ .
<br /> Character of soil to a depth. of 3 feet: - •__.___- _- - Water table depth
<br /> ISEPTIC TANX L T:Pe/Mfa - --._---, rara:icr - - -.. mo. Compartiienis
<br /> PKG. TREATMENT PLT. FI ',ype;flfg -- ------�--_. i,.,c,,�r.4ty _ —__� _ Method of Disposal
<br /> SEWAGE SYSTEM - i?istance to nearest:' Weli -_ _-'o.r'tiat hr � _- Property Line
<br /> DESTGUCTION ❑
<br /> LEACHING LINE ) No. b Lrngth of lines - -_--_-_ Tptal lenpih/stize -- ---�
<br /> k
<br /> FILTER DECOis!ancv to neare%' 1>•' '._ _froperty Line
<br /> SEEPAGE PITS .__ - %urhnr -- -•..__-.__.._..__ .
<br /> 1 SUMPS - ,. �.. ..... ,'rRUerly
<br /> ;-it'r.nrn to r:ea r-ntit: ,.1; :,• �,,.
<br /> DISP05AI PONDS !' 8
<br /> ,I he, certify Ihdt h:,•;:' [-Yi'^dYed t"i•. .,aniica:i:r., r•'.0 in accnrdance
<br /> with San .loapuin cn'.nty
<br /> S - - - lid rd}r> ant'•-r ltlia'.,nn, t•.s ,,,, h.rDis—ift. t
<br /> i ordinances. state law,;, a - - .
<br /> �l HO^•,@ Owner or I iLnn crQ aU°' Signa t❑rn r,rt it i,'SnChw in;iR�' C^rtl , Cha. i" thn nnrr0,-gylnCn pt the work for whifh Chit .
<br /> Permit to +orssu,?d.it : ;'i^v d"'. rnr•,nr, r1 ,.r''' "•, - n' Su7i••CC t', 'nprir+.ln,, Cnmprprsatinn law', of Cal i'nrnia, .
<br /> "' " r "i r; tn.1 tnn n•'rtnrmmncn n' thn, work tnr which ..
<br /> i Cont+'BCtnr'S nl "': O'15.,:,.� •rarii � .til^. ti,. r x ..
<br /> i i -, r „ .. ,-, ;,..�•, law<, of Ca4'tnrnia.
<br /> pe—it ,, isaun j� .y7 ;.gin _ .,.a :•
<br /> the anal,;i an, ^,l [1�1 cY`T��, �- ._n•••-� ._.. -- _.-_. Da tn:
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