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<br /> =.-_-.. FERMIT 70. dirt"
<br /> DATE ISSUED
<br /> tnc: a cc•r-•,: to ' t'w_' an'r�r inscal! the work rtereia
<br /> Appiic3tinn is hereon made to the San ,'...•,err ca H2a!tn -
<br /> desr,r7hed, This aPplita:7on is iniac Inc :zaca w'.-r. Sar ,..'rt., 'r1'n!nr_ 17 '4fn., sewa3e or No. 1862 f„r weli.!pur:p
<br /> a^: :h,. F.ule nd R,_guiation5 of the 5a'iui•I , ,r; t!'.: •.. 0'�- '
<br /> „ra f;r;dress��3�-r -� 1�4�__ -- -_�..-_^� �--...•'hone
<br /> hdmn Yr I` .,-_._Address - - a^
<br /> Mine
<br /> Contractor',
<br /> TYRL OF WELLlPL'MP f'OREt ; `rEL' Dt SEL'_ E”
<br /> .- OTHER (�
<br /> PCt4P I F:IOr+ !-I $YStE^! REPAIP i_ _-_F.
<br /> BOP LINE `F j
<br /> DISTANCE TO NEARES_7: SEGTIL TAAY. _ _ SE - Pl-SISUMrs
<br /> [ttT£t;DEO USE ---T'r.^E F L";1-- fROIILEY. :..=.E, .':S'P! 5^ECiF1C1Tl, S
<br /> Oia. Jf Well Exr.avateon� 1
<br /> II_j Industrial l�/Open Bat[en; Y Manteca
<br /> X1.I kStiCYPr'vd to �[!Gravel ^dC�. - racy �---
<br /> I Public o' Woll
<br /> /� i�Other ��Delto TY;,. of Cas nn - 7 --
<br /> F-.. Irrigation Approx.
<br /> LJ Ea stern Spec7fiaitions
<br /> — Deptt. --�
<br /> Cathodic Protection Do,tn of Grout Se.'1 --�-
<br /> r �
<br /> I iGeophystcal 7� e cf Grrn,t _-¢?H.,]G�tJ_ "C-
<br /> Uother $urfa� Seai Installed by
<br /> Repair Work Done T,)P" of F[ N,P. Sratq 'work rinncanp .-__.._ ------ w-- J
<br /> ,;ell eiamnn
<br /> Well Destruction eter Seali
<br /> U .-------- —
<br /> neptl• filler Fiaterial (Go!nw 501
<br /> i ^,•, Septic tank 0^ so,;page pit permitted if public sewer is
<br /> TYPE OF SEPTIC 'dOR>:: i1EW i'IS iALLATION �_ tLP,'11/'rGUiTIO+I !_J available within 200 feet,}
<br /> Install4tior� *rill serve: Pe5idencr :0rtmercial _ Other
<br /> 1.nt size
<br /> -
<br /> 'lumtr_r of tedr00ns
<br /> ;r0ober of ;iving units: --_ ---� Wdter [stile depth --
<br /> Character of soil to a depth o' 3 feet;
<br /> Cap•1city ;;0, Compartments _
<br /> -
<br /> SEPTIC TANK C' Typei T 9 - -- �- - Capacity - Method of DiSPo5a1 _
<br /> PSG. TREATMENT PLT. LI Typel-Mf-I ,-.---�---- _~-Property Lire
<br /> SEWArE SYSTEM Distance to neare,*. :well �-_- _ rnundatron -
<br /> �- lenn'h/sizt --_-
<br /> LEAC�WIG LIME L✓r No. : !.angth 0, itne5 -
<br /> rnurd.tin, Pro!,Crty Line
<br /> FILTER DELI _i DiStdre•� to nnarest- '^_lI -:_. - - - -- -- --- ---_.—�-.-
<br /> Sr_EP,',GE PiiS _i Depth Size _.----------- -- Prnlerty Line
<br /> - •'.ancc :o near::;t: ,,:•l} Foun:auur. _--�-- -
<br /> OTSPJ5n1. PO':D$ - E-'
<br /> -r,:d [h:s ac,:,'.a t;;,�, ,end th.,r Ckr work. •.'II he 'lone 'n ,,ccrrda nee with San JOaquln county
<br /> I hCreOy CPrl.i r/ thd[ 17'v" T'r` NedlCh 01;tr 7C t.
<br /> nrd:'lances, i'.dV 'ads- J4d 'C:`5 an^• r'equlatiGn of '.he �'�: ,4S^.',I!_ ;.i Cdl
<br /> f 'iow:n:: cer[i'y that in th' perfUr:nancC 0f the work far which this
<br /> H,v-e owner or Iiccrscd a;crrc', sign7arre Cert
<br /> ", 0' try h�,rurc sua.}.Ct :n .•nri,-+an�.Comwnr anon laws 0f California."
<br /> I SITai+ not C :1', al+r OCr "r ', S,l'r r-tnnn, r n the rfnrm,,ncC of the work fnr which
<br /> ger^r:it i5 iiSueO. gn,7Ire .. t,fir.q 'h" `_lirr,:'ter:� '[ certify hat t F^
<br /> Lon-raCtOr'S hir-.rq 3r sub-Cas:rd!'.1:10 5.
<br /> •�� r , Liao law; of �'alifornia.'
<br /> ! ha'.1 "-i"L'i i�'r=r71'•; SLJ t!.'- tl - - --..
<br /> this r?r^.it is iiSUC-1, 5 - - d�
<br /> ct= ,l rawinr I,'� �ev4r5e ,1 pa tC: _ �•�-f_f/=.. �
<br />' ;7e Ji'pl r:an t (I" 10r3/11%r eauire^, :rr,p,.:Ct7 •.
<br /> j;nneC .t � •__ -'f:�L�T/S.'�/' ,C�__ .' --- //Z7 ----'------
<br /> /�Ji(y,,r/7:.• .F.fi_67BL
<br /> r:pi!ca:inn �.. �:. K--'=-_: a,,i �! t-, Lodi 369-1621
<br /> ..'.ei tic..,; [�:r•.r•r-n:_. _ --- ----'------- --- 823_7104
<br /> rit
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<br /> r y 2"i5-F3F;5
<br /> p (r l
<br /> 2001,, stk.. CA 95201
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