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If <br /> APPLICATION ' <br /> SAN .IUAwulr COUNTY PUBLIC HEALTH Sl"I#ES <br /> ENviRONmmTAL HEALTH DIYIS OIt{ <br /> r 445 H SAN JOApUIN, PHONE (209)48$��� � u x <br /> r`Y P O BOX 2009, STOCSTON. CA 9 201 <br /> EXPIRES <br /> =c {Complete in Triplicate) f 0 x r <br /> fi- <br /> �1 <br /> Ilp➢liCatiaa 3s hereby mdrt to Ban Joaquin County for s peratt to construct and/or lnatrl.l the tort 6eretn descrilfeA. This <br /> •pplicstion is psde in eatpl3enee frith Ban Josauin County Ordinance Ro. 549 and I$Q aryl the Rules sod N*Culiticns or S" <br /> {} Joaquin County Public 1lerltb Services. I <br /> - Lot Size/A=reads <br /> f Cew ��� <br /> Job Addruas - <br /> NMne CNu <br /> Address --u't�$r Phone <br /> -scense N PhVOe <br /> ConlNcta' �-Addresses Ll� ��� <br /> I. ., d - WELL REPLACEMlNT f3 DESTRUCTION Ll Out or •rvice 11 <br /> r HYPE DF WELLIPUMP: NEY1 WELL ❑ lionitOrin[Rfl11 ❑ <br /> h PUMP FNSTALLATlON G <br /> Sys-.EM RE�.tlq C) OTHER O <br /> DIgTANC�70 NEAREST; SEPTIC TANK �. SEWER LINES <br /> R DISPOSAL FLD> fMDP.LINE <br /> FOUNDATION ��� AGRfCULTURE WELL DINER NIELL g7SISUlePS <br /> r; 6 <br /> INTENDED USE TYPE OF WELL PROBLEM AREA <br /> CON Til SPEC!F!CATIONS �,of W"CO*V F <br /> u'aL� ,?i C1 tnduesrlal C3 Opsn Bottom <br /> ❑Manteca Du.of Wei Erearstron <br /> nx� s, ❑Trae Type of C4"-------------- <br /> Private 1 <br /> ,r. � k ,`'� f t Domeet3erCl GrawM Petk' YTree et <br /> I'1 PuDtk n Dow Il Dote' Depth of Grout$sol _ <br /> " * � I F IeryleElon APWos.Qepth I!Esslerrn Surface Sart Inststied Seita Wort DoH <br /> N.P.��—�--- <br /> y i 1 R w ,msReee <br /> sG] 'Type of PurtM -�- mit( ;!sterial i Depth _ <br /> i a 1Nra1 O+stfue;ion ❑ Woll Dismster �QQ� <br /> OePIh rIllvr Not* <br /> i Depth <br /> rP#O & TI WORK: NEW IAISTALLATIDN t.I REPAIA11*411 <br /> lADDITION _:E STRUCTION I I w�iaGtet syseatit <br /> wn ALTii� SEERY�IGKS f <br /> _ ENVIRONMENTAL HEALTH DiylSkO�t <br /> • R• $ eS2 -' IflitlE6SkJl1 MN!MIM ;RPbAe AGSCMMflNekl "Ot!•.n -.�-� -e- r 1 + <br /> ' y NrJntlrM,ol.Nvvk+O unka:_�- Nylnber Of beC/t►pene WSW s"ftuh <br /> .Cte k <br /> pf"0 10 a depth Of 2 feet <br /> ChrKIM Capacity�,�—�-� a� <br /> iR rrr�lc YAs�lc. „ Gt r �Mf>a wI.t►bs of I wp" S <br /> t�i ►Ka TIIEATMENT PLT �} ' ��yy,a,e,4.-' ire r <br /> r �)LE D4tana to ttesrest Wei i.�s�-•-- ref OP�fIY Li+s r h <br /> � r1 Na,i Lenpth d r/m7'. --- Total Ientidt/aleft - <br /> l.tH[ N t w- <br /> { xk¢fia LERCMIMD 1Nei wS'r' Founastbn,Ts�.--- PropRYtlne <br /> 4 �r FILTER!1[D [7 DNRanca to nssrast ; <br /> ' Ft a+'REIFAQE PITS I! �7Mh - Sire _... Fburidulon '...1..'.Profit*LWO�•..� r� f Vie'. <br /> SUNIPII , '�' LI t7letOnce se nserest.• ,Wdl <br /> es <br /> ` DIiPOSAL POND6 ❑ hats iws acid} + i <br /> '1"" 21 t parlSfr_that 1 her.pswfea this epphCaIkn and that Nee work wR!be done A acto danCl with San Joegrel!t eowety a4ln+nc+e <br /> r i' ►itlas Mid tegiststbne of the Son Josey a eMiti�ia the follpwlnp:"i cortitY that In the petforrnence of the wurM la which tltht po mN is lewMd:1 MNd not rt <br /> !xy °r �hji porion Inlet SWA"*~as to beaoma aubteet to wakman's eompsneetion Uws of Cstlfoenla."Conttaetors hiAn9 a waeansettotk+p�~hem <br /> x 1 wnffY L'`t In Iha WO?manca of the wwk for which IM parttrFI 4 iwJ"-I Nal t+rnpbY Porsaete tetgede ro worltnfart a patnpartea- <br /> <� r' � crlAlRp tdlp la[pwltffl _ <br /> Ist" i* call iw tai.►#tWtse Inspections.Complete drewinQ <br /> on nvene sine- ti <br /> / T!u ttpp3rt Mf1 crvrol <br /> Tile: <br /> FOR DEPARTINETIT USL ONLY ' {H <br /> t 1..3 Dene g� A <br /> 6+ is�d rid App*.o0 i AKptad by Oae> <br /> v of �TPIt Or OftMr1 ele�ePeatfon by l Date -- Fktel I *: <br /> - <br /> ' ;Addltlernal CornmRttt� K-1 <br /> 9eturn Rll'Coptoa t0: 'San JoaQuio County Psbllc dealth Berrleve <br /> API13csv4 t <br /> ;I�;�, �y -.7tur2 gpale7N1RI iealth Psrwlt/Sorrfeasa <br /> 445 11 BRA JoegUif"P 0 kkjkx XWO. SRker OA YSzit11 x ,.•.-:::'%. [ y.,:ez <br /> ME <br /> yiN►OAMOUf47 t►VE -'i:AOVNT IIEMFTTkO „: K[C11VE4 w <br /> two <br /> + Tie <br /> "q,46* <br /> - J <br /> X51 <br /> i <br /> .. +.. s .,... <br />