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APPLICATION FGt3 PWWIT <br /> am JOAQUIN COUNTY PUBLIC IIIALTH fsuavicub PAYUV4T <br /> XNV11TAI. UK"TU UIVISION <br /> 1601 u. ATNEf AVS,r-PIKINS (209)466-3420 RECEfVED <br /> P 0 80X '2000. 3TOCKUM. CA 95201 t1R,.:. fi <br /> r j►BBYIT 1B><PIH1B3 1 YXAIt�. l n�Tx issui� SAN X►Q't►.N 1,1 Y..NTr <br /> (Complete in Triplicate) PUBLIC HEALIm S`'PVICCS <br /> ENVIRONMEMAL"tA.TN DIVM0r,,. <br /> 4pusetloe to hart./ mme.to hoe Jo#quie County for •9art4t tv construct and/or lu. t&U the York terete dentcrl6#tti, TM* <br /> sm"66"m is ads is *0441eeoe rith Sae Jaiwio Couaty tiratnaeo# No. 5%9 and 1862 and the Rules @Ad`fif9ttla�Ciiiba"aT Mn <br /> Joao"Ceomty futile Meelth Ser"e". <br /> Ja0 AMM# — f g!n F 1A Ay., - _ C,tr <br /> ' �] /� � fir+ /h. ";�I •1,. C S <br /> OeeMn•a Nance �� rut�ry,.-4 `J�f G�1 fii�lnt 1..�l._'�,.l�._..'w�1�::r ,t . P�._ <br /> • <br /> CMp1tNfr lost tV3`(1 bene <br /> Y_#Of WILLINMIs NEW WELL WILL RjVi.ACIMfN7 C1 DESTRUCTION Cl Out of rv&" V.31 <br /> PUMP INSTALLATION U SYSTEM PEPAIR ;i JTMEP F; <br /> Moett"404 Well <br /> WSTANCE TO NEAREST, UPTtC TANK �t.�. SEWER LINES --_ DISPUSA� FLO ►RO► UNE } 1Q <br /> I FOUNDATION S-.r AGRICULTURE WELL _ OlmiR WELL_� 01TSrSUMPS <br /> IOITENOEO USE TYPE OF WELL 'ROBLIMARIA CO_N_STP_UCTION SPEC1i1CATIONS u <br /> 1 fetdtfaMtrr U Ow Sataft I i#A~d ._ Ora of War ace Own Ow of Wer Catwq <br /> I I Doetaaats/PIMm VCo"Poo I 1 T►ecy. ivpe of Cae•op . St»ctt•cattoa <br /> PlowI i OMrf I'I OMI# Depth of Gowil S#M .�'f'.ti[.�1 1.�}�a 01 f. cL'.r. <br /> . 1 Mteellal 'zy Awe. owl, I I t"W'. Sudoce b"In►te'eA Or � <br /> Ropes Work Dar U Too of PuRV _. N► Stete Wa11 Dom <br /> woo Dwvw wt Q Wall Otalnatal N"l,04IleteH�� D"th <br /> n1Lr RatoriM • Wpth <br /> Tv-4-37-0-IFIR WORK. IOW tNt/AtLA11014 I I KFAIIIIADO1140141, ' Uti,1Nt)ChuN• 1 INV 6 WK 11r11te0 pettoulled d pldtat new«M <br /> rvadauw vAtIm 200 feel.I <br /> IM1ayMen vA fww' Raaldeftw. - 460MW$iO — 01101 <br /> s <br /> twlfMan of 1wr15 ON, "willow of"0000... <br /> aw"W of welt to a MPP►of 31"; . .__ ____ ____--. W 0#I«tatlM daoH►_ <br /> SE►TIC TANK Q T"w/Wg No CoOpartm«+q ^ + <br /> PKG. TREATMENT KT./:t Mem"of Dyp" _ <br /> 1 DNtfog"to nw*M, Wer .`.w_.. fou.wfel un . .. _. __ Pto1»nv Log" <br /> LEACH"LINE CI No.S Li tplff of lore Tota Ienylh,We <br /> F�'ER SEO L1 D»t&"to Anent: woo _..__. Fu�,.auon Pt~V line_--- <br /> SEEPAW MTS 1 1 <br /> SUI11P8 l.1 Dtetan0e fr eeM.t. Ptupenr LWA _._.._. <br /> OtSPOSAL PONOS (I <br />+ I heroby temify Chet i two pfap«ed"we apokstmon 0"that ttv*10#11 W,.:Ge done a ect,u..idnt a wdh Sen io"wifo County ordeuMltM.81a611 ISINIL 04 <br /> tube andwOuMuonr of 0#w ion JO awn County <br /> Mo111e ewfrf Of htMrod#pMM•►wp Uo#C#1ta.ee the IoWlhMrp "I Cen.ty that M 111 peAo-m•nCe of the.►0011 RY11"lor eCh 1P41104 M*t*&I e11ae net <br /> antpl#tt any patois M auto fltafYlet w to hetottue eufipCt w wa►0eo'e tompemat.on tewe ul Cr:,lwnu Conuectof a herq a euOGOM►aCtMp IYgnalun <br /> N <br /> twtAMe 00 loaowrnp:.ry Comity Ilrt M the PollwW«1Ce of the won lot which th.4,penn.l 46.66u".I#nail employ p«sone PAOCI to rrofkAlalt'O fes" <br /> W iawe of Gallons' <br /> TM appwtant WORN CM/lot 40 1eglete0/916111tlwne Coo"io 0aw+1p on rev«11e Mae <br /> +T^ O M NT USE ONLY L <br /> Aaplocatan Accepted by 11 _ Dao` / U Ates <br /> �./1j r t DIM U ,, `� feW Inepettgn by <br /> L1t3 L e n/f pent tl 0 't 0 <br /> PA or Ofout wapecten tw i-+— <br /> A001wnN ConYn«1a; <br /> ,Applicant - Itetura all 0091#0 001 tion J"qula Canty Public Ile"th <br /> Servlca. ptviromwet#1 Health Perte1t/8erv1cee <br /> 1601 X. Ilareltoo Ave.. P 0 hon 2009. S"tkttm, CA 95201 <br /> ntt AMOUNT Out ^MOUNT heMttttO hiC11VID 0#r Deft P PIAT NO- <br /> INnO � <br /> t <br /> i <br /> 1 <br /> I <br />