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<br /> APPLICATION
<br /> IN
<br /> SAN FOAQOIN �_ p�ADIV SERVICES
<br /> ffiVaOHSffi1TAI $$ LTHI3IOi
<br /> + � :i '.f 445 H SAID IOAQUIN, PHONE (209)468-3420
<br /> t;' P O BOX 2009. STOCKTON. CA 95201
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<br /> PMRW T T EXP l is _
<br /> (Complete in Triplicate)
<br /> Ayyllestion if tAreM mLds•-a-Josqula County for � permit to construct ae4/or 1nsu11 tiw ort here dsferilkd. TRU
<br /> application U am* is CeMliaaee rlth sea'JoaQuun
<br /> tn County Ordtnanee Fe. Sl9 SM 1sf LWd the files am MEulatwas of Sea
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<br /> :0squio County public Eal tb Srr.tCsa. + 20 AC•
<br /> R i Gtr 1114tia lot S91erACre44e
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<br /> Dole Fresh Fruit Co>Apany Same P (209) 334-278
<br /> ?'I' Ownar'a Narna Ade.rat —
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<br /> All Terrain Exploration 6330 Brewer :iaad
<br /> est Ctt\uaela� O ill —Address u1..•. ��. rrnvL rat _—LKr*ss No.a@1+3I$3b—PhQ11s
<br /> F t HEW WELL C L YELL p;PI"CEMENT r; OES7RUC710N [i out--®ri<s ll
<br /> YPE OF WELL/PUMP, P"Iterlwa Vol'
<br /> z 'r �---�—� SYSTEM REPAIR C OTHER O
<br /> PUMP INSTALLATIDN C
<br /> DaSTANCE TO NEAREST: 4EPTIC TANK SElkfiR LINES �IA . DISPOSAL FLD..�_��"�1Af_ PROP•LINE 12Rt
<br /> !QA AGRICULTURE WELL OTNER WEiL_ ZBPITS/SUMPS
<br /> FOUNDATION
<br /> t F TYPE OF W1Ll PROSLEMAREA CONSTRUCTION SPECIFICATIONS
<br /> x: INTEND D USE Zit Y.D.
<br /> #' a 0 Indowo C Ops^sonar ❑Mameu bM '�WM Eacsratton PVC
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<br /> Da+retKr9rnet. Q Gram)Peck L7 Tracor Tres of Co" r`.
<br /> n owe Depth o/creat SaM 3 T1iFre o+ Cement
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<br /> t.S of ae11 tY■death Of 2 toot:
<br /> SEPTIC TANK, s._a Tw.rolwc.aautr
<br /> PKG..TRUTMENT PLT.Q .' IOAQ INC 8 z;, L
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<br /> Dlstrlcata.NeRu: wall Folrwstion �1fICESka�9 y
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<br /> LF-ACHING
<br /> ELINE Owanoe to norm: Wall Fornc own
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<br /> ,f.�.�.I&Wa rw rw Cw Boni .CWW$m th0 40+WA":-1 cher char in eha pprlorresilCe of the work ow** h 6t 0 Os►n11t a iaal/ad.-1 rIM nfu
<br /> means pwea a 6aarleea sage riynn+Mo Calr/ort"."Convector hirttq * •
<br /> K IIIo1MIrr of W aaoOnM r1bon to wotkineft,r axpip \e 1"Ift Lowesow pore" 0/ i p!t1YSGor faOnMllr ,[
<br /> F y 3l� ..tIfIM/11s fesowirlp t 111 tlN prAaewrce of tns wok for rrlroh tlra t}anM s sNltsa.t tat/H srtralolr 9sts011s altbFtCs M rrelYltlse's C4RgI,OMatt•
<br /> Non(arra of CWlanrs a k *'. Yr a> r •,» ; sfi � "�; �r s"g, y,5
<br /> ,F �s'rhs rpplferM F II1lpsCbfMla.Canalsts dferrM\0 an teMtM Sift. to 1 .w ` wk
<br /> A ;.r � T Vice'President M�Yj �,.fSild;k
<br /> S40W <' Tate: �y.
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<br /> s sr eft C Sauce FOR P SENT USE ONLY r. jr
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<br /> " APPlicent.p Return all copier to: ' San Joiauta County Public Health 8*rrless tii."?'l' r,• $`'.
<br /> F Y'� rnNr iron"atat Health lbr"tr Sarv2c*a i +a �,•!o t -
<br /> _ .' S it SyY n Joaquin, O lion 1009, Hoke. CA,99101 _J'i qY••w �,
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