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JOAQUIN COUNTY PUBLIC HEALTH SERVICES
<br /> ENVIRONMENTAL HEALTH DI ISION
<br /> s N SAN JOAQUIN, PHONE (2091469-9420
<br /> P O BOX 2009, STOCKTON, CA 95201
<br /> ERPIRES ?. YEAR FROM DATE ISSUED
<br /> (Complete in Triplicate)
<br /> I.pplleetwa 1t r-- - ^iuln County for a peralt to construct arid/or tnotall the Vora heroin daarrlbed. This
<br /> Application 1. - - - ••.N Ban Joaquin County Ordlnsnco no. 549 and I662 aM Rules RuLand Postulations of Sad
<br /> .Yotiouln cT,ntY :'1 ••V .
<br /> Job AEON„ _l'_^_/, �_-.`// I /(�/f,_y� f1�CnvL1�Cj��Jj{//wt�ttllte/Ac reyn pp/G—
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<br /> conVancr��['t //i;•- Ta,rs,.t LL/L{-_.lMIA-4cJ—L-CIM0 No
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<br /> TYPE OF IVI- 'r"• .. /. WELL WELL REPLACEMENT i I DESTRUCTION �I Out of DorVlpe 14
<br /> -- - r „ATIGN y SYSTEM REPAIR .; OTHER C, MunitarllfI well I7
<br /> DISTANCE TO N"AnrST -• �. SEWER LINES __. DISPOSAL FLO�_ aPOP LIN! ,f f
<br /> _ _ A_ AGAICULTUAC WELL �= OTHER WELL ►ITB/SUMPS [.4l,�
<br /> INTENDED USF 1 %%rtL PROBLEM ARE, CONSTRUCTION SPICIFICATIONt y
<br /> uatnal -- n- - -- ❑Minutes Dme of Wed F.eawllon T' OM of Well CAW" )�
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<br /> 1100110 Depth C'.. SeN QQ� IYw of GN••n
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<br /> Wan Dntmetrar, w•� Bowling IYvrlal a Depth
<br /> 0.,..... Fluor material a Depth
<br /> tVpE OF SEPTIC y„n,,, N c t.I i ATION 1 I REPAIR/AODITION I ' DLSI CTIDN 11 'No WPIC spleen plenvnW O o.w owww r
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<br /> ___wood,table depth_ 1
<br /> SEPTIC TANK i,-- CeoatpY No Cwly,snensnH
<br /> PKG. TREATMENT III T [I Method of Doppaal
<br /> Wen__ Foundot,ce Poor", Lo's
<br /> LEACNINO LINE '1.. , 1,•n41N 0,Inge ._ Total
<br /> /ILTE. ED (I t• n. N.•aar,at. WON FwmOalmen_ Pworov lone
<br /> SEEPAGE PITS — --- D•••'r, _ Son __ ___ ___,_ Note", ---_---
<br /> SUMPS I I Ing rr Hemi Was_T. rourittso n ProPeRV Lde
<br /> DISPOSAL PONDS
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<br /> "S N Fan Joeg111n, 1, 0 11nt 2001" Ilan, CA DIM
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