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AFPI ICATION FOR PERMIT
<br /> SAN �OACIUIN '.0( AL HEALTH WSTRICT
<br /> INI) F )iA/_U -10N —,/I- CA
<br /> ((-!ttfIfl(llIf 12091 4Cj3 6781
<br /> PERMIT EXPIRES I ',EAR =ROM DATE ISSUED
<br /> AfI"c......I Is tin uh....... to Incj .......... It I.0NI Ibu ,or k h,,r-I descriheld.Thit.ii,plil'free
<br /> rix Illpl h,l, a, .........j., ........... ......I ......... of Out Sir,,jr,iuuou
<br /> Job Address /I --,v Sue --cz g
<br /> 0,,f...I,Nunn t f—Y Phone
<br /> —A—L. L.,,,.se rfl. Phalle
<br /> TYPE Of WELL/PUMP NEW MILL I WELL REN ACLIVIENI DESTRUCTION i 1
<br /> PLINIP tNSTALLAT,ON 1 SYSTEM REPAlk OTHER TI
<br /> DISTANCE TO N[AnZSTSEPTIC TANK SXNER LINES DISFOSAL FL:) PROP. LINE
<br /> FOUNDATION, AGRICULTLRE WELL OTHER IAEU. PITS/SUMPS
<br /> INTEND DME 7YPI OF WELL PROFI EM AREA (--ON9TIlLWN.)N 3PFCIr1CA;lONS
<br /> I Wdustral i j C,,,,n n.frin M."',...... Dar of Wolf Ex-oval.... pia.o
<br /> I G"I'M Polk I I fww/ Fitful.1 C,i,.,l,l Specifications
<br /> fit. ' 011.... I I r.1rp,f Deud,.1 (;,"a sr,fl T,,a of Grant
<br /> A,,,ro, 0111l, I Los...re slill.1co bull IllswIlud by
<br /> Well Destruction I WOt D.Iml:ut maeral lf�,i!X1 I
<br /> Depth---- --- Filter malie"'I Re'll,Y1 I
<br /> iiip,q Welk rune I I Tyr,- of fi,,im ILP Sri,,,Work Dore
<br /> TYPI OT SkPrf(: WORK Nf.W 1NSIAI —6 -Ill,,IIItIiT-h)N I IN,srpht. ly,nern pontlawd.1 pubbr ll is
<br /> oul....201)!o-1.1
<br /> Installation wall"",wl ✓ :,I,, lic"'.0 Ottr;r
<br /> Mu.1ml, of L,nn,.1."'I"
<br /> Nl....I I PI1rllI-I1•,
<br /> Character or soil I.,depth til:! hut. ___II I�,-/p
<br /> SEPTIC TANK 1 1 Topuflilf,j ".ipwry No. clunpollarents
<br /> Pill Mill NT PLT.: 1 Kiivluld of Disposal
<br /> O"tan-a to nem Wulf i F...l"I I Properly Lill.
<br /> LEACHING LINE L. No. &Length of fine. K A. ti total onulf-i -4b-
<br /> FILTER LAO I Distance to nfol VI,it Fo.....I'll u,ri Property Lino-1w
<br /> SEEPAGE PITS i Depth S.,uMillibar
<br /> SUMPS evil rollo'll""ol �CI. ,, Property Lin
<br /> DISPOSAL PONDS
<br /> 1.1ifiroby torlify Chat have creation this 1p,l.,anon and that Ile' —
<br /> work I l,, ........:cidlni-e-it[, Sit, roomy ruchoopurs. let.laws, and/m
<br /> "es,and nufflin......of the Safi Jodqljlr)Local llc.Ilth Dliflucl
<br /> Herne owner of lirensed agent's signature can't I cenlly the in fill miloilialce of the work for which this pore,is issued,I shall not
<br /> arep4ol,an,person in such nionne,its to lueoulf,Su,jrc(10 Norklinjo N C0,1per5.1tion Iow>of California,'•Ct,tructor's hiring of sub contracting agrel
<br /> frortitios the foll"Ang:-I lately the,in thlearti,m-ru,of itm vve,k lo,Wild,this to......t.t:n,uftul.I shallono,,ity,pruscuortubject to vir.,kinate'a efornprons.
<br /> Lee,law.of Califfenert
<br /> The ap,fi-tru nuou all r utwul ilofeer.,s a.....lou ~nt on In nfe..do.
<br /> Signed%_
<br /> Tila: Date:
<br /> PLSa1>dAT-U$F ONLY lZ1101
<br /> Applir,jocri Accepted by Dole ',PZ ;--sr Area
<br /> Ifueoci )n Eup
<br /> Pit or Grout:rispliclion by
<br /> Additional Comments:
<br /> 0 Stk 4M-6781 L) I adi 369 3621 IJ Moll.,a 1113%104 CI Tracy fCf5CQ05
<br /> Applicant- Return all copies to: Fiivironell),flultil Polluit/S.IMIn l&II E. Hit Av,l P.O. Do,2,20,). Silk- CA C5201
<br /> 110,11"ED
<br /> FEE AMOUKr 06f ED by DATE PERMIT NU
<br /> ou 1324 IRIEV.I -11�
<br /> piria
<br /> .14
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