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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONK3INTAL HEALTH DIVISION <br /> 445 N SAN JOAQUI°i, PHONE (209)488-3420 <br /> P 0 HOZ 3008, STOCKTON, CA 95301 <br /> pS *T HT;PI Sg IXRAR FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> Aw110at1fI6 is ho"tW HILI San Joaouls County for a permit to construct and/or install tit work herein described. This <br /> swilsatleh to node is acwl"ce With son Jospuin County Ordinance no. 549 and 1862 and the Au1es attd 1141SulAtlons Of San <br /> jogttia camm%r P"lle MaI servic <br /> Joh AddrMs <br /> :74�� L..• �1 ( JA _ FC� _ CI+r00 A <br /> Lot JtasJAcrea�c���__ <br /> Owrrar'e Kama <br /> Address ill — Phone <br /> GpnhKlw - S_Address nse No. Phonpbervigoei"011 <br /> NfELL/ p: +. N J WE WELL REPLACEMENT DESTRUCTION ❑Out of p <br /> MJMP:NSTAL TI SY Ti REPAIR OTHER C3Monitarlos Well <br /> MSTANC!TO MI SEPTIC TANK EWER LINES ko"..4-1ASPOSAL FLO. III LINE <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS <br /> 1NTtN0Et1 USE TYPE Of WELL MOSLEM ARTA CONSTRUCTION SPEC:FI I S / <br /> Ll ai dgse n C1 Msnnu Ora.of WM Eauvatan D.M. of We*Cawnp <br /> p wmwclp,**" C Grovel Pack L7 Tracy TV"of Ca.np_ Specrf4ouons <br /> 1'1 r�Off, n Dsha Depth of Grout' T at tt."sul <br /> I� ....APPsa. +I Ewwfn Seel Instaued M <br /> IIap11r Mort Mss U Typo of PtshpH.p. —Sateorn <br /> Wan D _ <br /> rnOnaa Werial a Depth <br /> We OaMRaelrafl O YNsLO1rtMw '-TP_ nilly 7mtselal a Deptm <br /> Oaptli O <br /> 111#11C REAF iNSTALUr I t PtIAMI/ADDITION 1 I DESTRUCTION 1 1 seocrc orstem pstmead rl Ptrbhc s <br /> i avadwe vwttrn 100 test.l._ e" <br /> Maldasw_ GoltrttarcmM_ o0 w <br /> M"M Idiot 91�hsAroortre S <br /> of sol M a shlwl of J saes: -� _ Wnw 1e05s d.wh s <br /> TAM O ' TyplMis C4pec*y No.CorvMwtmwnb k� <br /> Nb0 TIMATMIiNT PLT.O Method of OW411e1 <br /> 71 OIms"w rowws: Woo Fotxtdetlon `'Ps eeft Lina <br /> Dow tdNE C1 Ara,`�i.wnpf►M tnaa _._ Tool Iwnpth/site <br /> iiS ND 0, 04W46 to mama; Wal Foundation Propwsy LI M --- <br /> (iElcPAtlE °8 1 J R1MIIt; -fys Nwttber _ < <br /> L1' OW&Mas W AM111114: WON Fourndalion s►oOafY LkM i <br /> t wctaaog .St' ` • <br /> 11II11Mrr sw*y 0014111 we VNI IIpId V*&VOWatial and"the won%RN Won <br /> Owe m accordance with San J06I county osdnfnua,us"lawn,and <br /> afalsea MM toaow.ry:"1 oaNfv that in tlra MAomsnce of the wait hr whrrh 011111109 is iasttsd.1 al+ea not <br /> 4Rrf-to POO"mum sa W ao«n.wlhlaa to wortRran's comowwiwn law:at CWorma.'•Confrenoes r rft at Alecontrusine OWWWar <br /> tllta taiwMYtK'1 <br /> 4M�1r Myr pM pAsn w icti of the wort for vA kh 04 AwrNt Is iaeued.I ansk employ p t"M MA""to Wartntan'$wrrvanra• <br /> Qha 1st .CemPlate dravrirts on r fids. <br /> TWC _� Daft: <br /> R Osp"Tuaw Uri ONLY <br /> t Aea'ptad <br /> r <br /> (map�y Goa. ind kllapscfion by (SSTs ;r <br /> Osr9ltWitest ._ skir <br /> sown _ tsturs all noplss to. sea dosrnls CoustP lio alth leeabervloas <br /> tisWlrOsssstal lualy !rs t/dstw " ". <br /> Ola ■ batt iaaeuls O X009, Ms. Ch 95201 <br /> 1�E AMMW OW AMOU11iff UMPT90 RICEIVID tY .10 <br />