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5''YS 014i.r r yJ _.. - .f,.. ,s _ I r{;i:r.N•4 _ r ^ <br /> s st t <br /> { APPLICATION ;�1dLLL; 1""OF 3 <br /> i SAN OAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> HEALTH DIVISION <br /> MVIRONNTAL <br /> x 445 N �AN JOAQUIN, PHONE (209)468-3420 5 <br /> P O BOX2009, STOCKTON. CA 95501; <br /> r li <br /> ti <br /> (Complete ifs Triplicate) K: <br /> r°vM•S_. �- , jf Sir i3 _ <br /> a { <br /> Fyr. I <br /> Application S■ Uetytry ar . Thin <br /> 4e-to San Josgnlo,county for a peralt to construct artd/or ltfatsll the work Utreio dne1� oT San <br /> , ,"h t '^ Y S.�7 !!� ttPPllGtioo 1■ PtrDIlcABealthtf3arvl eslr Ban Jeeputn County Oroinance 30. SL9 and 1862.aM,tlY! <br /> Buba &I 1110.. A � <br /> at, <br /> "k fi JwRuSR County i II + 20 AC <br /> 8751 E. HwY 12r. i.. C.rr Victor 0 Lot alae/Aer*ase -- <br /> P„ Job Address <br /> a a' 1 1T L <br /> �,= h •s Same <br /> :rrr �; Na ; I�.DwneraNeme Dote Fresh Fruit Com aril Adan■, 3131/95 <br /> r' All Terrdin £r-pioratiori 5330 lSrr_wer Ro edr.� LKense rlo{r 1�1G—R=te '9 <br /> - <br /> +� I f ;I Conlracla - <br /> = 1{� ` k TYPE OF wELLIPUMP reEtM WELL CS wFlt aEp1ACE ENT Cl DESTRUCTION C1 Out of 1torlea 11 <br /> IIoelWritrE well ] <br /> e - SYSTEM ilEPA1R ❑ OTHER Q <br /> NA 10t ►. <br /> Mir rJ .fi - PUMP INSTALIJLTNA ❑ NA DISPOSrt1.FLIJ. PROP.LINE .� t, <br /> i {+ SEWER LikES ��T 29 PITSlSUMP515 <br /> �r��'azu Dl5TANCE TO NEAREST: SEPTIC TANK <br /> r�a �brl r'yby t' FOUNDATION ' � AGRICULTURE WEI1. OT„ER WfIL <br /> s !P ROBLEM AREA CONSTRUCTION SPECIFICATION$ <br /> INTENDED USE TYPE OF VYEiI Oy WON n i. <br /> d Casing' <br /> ❑Open Ronan 0 mfintrta W.of WM Eacswnon � Srsl_ 4fT <br /> = 1w �,� �l .(7 Indualryl I❑ Tracy Type of Casing- <br /> ti, fjE DyryatiCIPflrate C'F Grtwal Pectf C1 Oefta Depth of Gran SRN 34 t Ttrpe d v <br /> ��y .{ :r 1 I. 1'I Prblie !7 0{herTRANS TECH <br /> I t W p`� �� 40 Approa.pspih i I Entan Surirp Ss+d InatMwd tfy <br /> �5ks M '�I 1 Yrripilion 1 <br /> Sus Wort Dory <br /> � f Ak' } ,Reel,Wort Don. E3 Typoof Pump ilk -- Saalln[lYterial i Deptts_ <br /> ` ❑ Wal Di.msur {• <br /> -,WON Daaructwn Depth <br /> , '� - nuer riai.rlal fi aeyts, }{ <br /> �, r i1 � `� t. •��� Irl <br /> OAw v.Num 200 last.) <br /> FSEPTiC WORK:. NEV, fNSTALt.AiION r 1 REPAIiIiADDITIr)k I i ,OESTRUC7ION I I Nµ =c d R"�'C+�' <br /> lnauasdon wr7 Barrs: Re/idn�ta_� ConwrrerC+r! OthN s I vt <br /> x r=� Numbs Of bedrooms � �. '{.. .,,4. �.• <br /> � ; NtNrrtter d ivin0 rrnita 1. Weser MOM depth <br /> y `Y of a hrt: } <br /> y C1KefaiMf d eoE to a depth <br /> F EEfrTIC TANK F. ❑ Typelf.HgIt <br /> 4Pfca TREATMENT PLT.a <br /> i xxy�fjg Y f t DiMna to rria+eat: Wel Fowtdation �> Y D <br /> r: � 4 3t y ` .r <br /> - ,T r 4�,�. <br /> Total Ia"NOW51ae u1"EAf� <br /> LEACNtfdG LINE CI No.i Length of I rail - <br /> ..;_: <br /> � F FILTER lSFC <br /> ID ❑ Oiaturce io rrawe�t: w.r :Founaat=on P�of�r�Y 1NTY a <br /> E.. _ .il Sir i` Nunrbar'L Y15S0� 3 <br /> ti SEEPAGE PITS, I I f).oth li+t+ t' i <br /> _ SUMPS ` L1 Diatantd to twwst: <br /> was foundsston ” ; F <br /> DISPOSAL Q <br /> 1 hereby eslnNtr eMt I he"prepared <br /> thM e04�n and that the rtdrt will be done In accordance w�M San JOSWAn county mOnMKes.aMia Mwe,arta <br /> cobs Mrd►epufatlorM of Sty San Joel county <br /> tea F 3 Sure Owtd"tM fowvwro: l eerM1 tt+et irr the tteAorn+.nce o1 the wort fa wwkn gra veinil 1a liwea 1 ahir rwt <br /> 3 I 1.. *'-Nene owner a Iltenaaa apevte'a Npns wortmen'e tprnparraat{dn fawn of Cawatrie.'^fomrecto/a hirY+p Or wlseonuacdnp <br /> 611060 al pawn In Rich rVV~M t0 beGdnM��M�let'1 q to teq/Ln1N{'e OOtrlp♦hea' <br /> r r = "t ,• M.y I- -,caN,Raa the foEormiNN :"I cerwy OW in the pwl d the wet to wtueh IhN Dennis R iaairea,1 a1raE ert+protr DararMy aLblaoi.. <br /> (ailrra of CaIRWnU ° ' ':•, ' " I� I w, c <br /> A t° f' ym appaI all taOtrired baprctions.Cwnows drsrwrrp on low"tide. -+ •>' <br /> f t �; 4 �I <br /> i. r'st` rL` [�.-g...w:.1::4''L'�.:. Trt1e: Dais <br /> IN <br /> s YC. Sauce •: DIPARTMINT IM ONLY =/�,� A q <br /> Date " <br /> i-H �' 7 `xr r . w4YYUt�. ural IMpaCtiert by "�'^ :�"t1 Dat+�¢iJ <br /> PN er hispeclion bY! fkt• .r r <br /> v 'A kilt"Conunena' . _ 7 y Y- A. <br /> ^ <br /> AppllcantF- Return el l.coplae,ta:'I Sea Joaquin County Public Realtb Servlceelr <br /> Fevlroweeetal Realte Perelt/servlcee •, ,,,,. <br /> sell It sae Joaauln. P O floc :ootr. StRe t'A 93?Ol . <br /> FEE AMOUNT DUE imoumT PI ,. RELINED ay 11 1� DATE ►[ItMfi"M0. <br /> nrFf] r a p W <br /> "fi r` -:�y�'�x•� SdeiH syr ra71 — 'F <br /> 'sL.isSEF`A^,:4 '..Ais�;dr+a'rwu:s.:1lr±vlle�+al4.e+:+rryy+yECx4. :.iy F <br /> ,-+���'�N• � ATP`. 4 QE i _ � - <br /> -!1 <br />