|
Z'
<br /> �yy
<br /> w
<br /> 4
<br /> APPLICATION FOR PERMIT
<br /> SAI\'{ .1OiAGUIN LOCAL WEALTH DISTRICT
<br /> 1601 E. I-fAZELTON AVE.. STOCKTON. C4
<br /> Teleptroone {203) 466-6781
<br /> PFAMI T EXPIRES 1 VEAR FROM DATE ISSUISE."
<br /> —� -- )Completo in�Triplicatd) "N?
<br /> A pr ilication m hemby made to lint!San Joagrin Lrr•.al Heallh Diso+ct for a parmii to construct and/or insult Ow wOrL lows n c4uy;•,n:rod. rt"O;roit)it::rtlnn rt
<br /> emou In romphnnco with ran J(rnrluln County Ordinanret No.549 for saw"it or No 1tW fm wolfrpump and tiros Hulas acid R#Vtilatior+a of the San Amouws
<br /> t nt al {lost{{ D•nrricl.
<br /> Jul)Adoftms �.� J I 7 F.� )'T+/:Il�tre A. __. .. city Lr,*S{sai -__-... PM -
<br /> (7wn..r't"Jernr• � LAY 4_ /All -2
<br /> 1 rr-vnle NO.
<br /> T�,�'ir'�__ :fiano._'is`�•.��• K� _�:
<br /> c YVE Cif VvULLWUMV• Nf :Nfll WELL RfPsACV-4NF CIF.S7PiL)G71(y,V I i ry
<br /> PIMP INSTAL)ATION rrYSTi AM AEPA+rf
<br /> fr;fl9Nr•t, rr)romif'if VI"(11' TANK 9f'1NLftIINVS flitPG%ALfoil PROF {firf. i y
<br /> fQUNOAiItJf) Afiiil(alLTUiBE Wall _ _ L)TilEr+ ''OJELL MTS;SLI:.RF'S 4
<br /> g
<br /> I'M Nut U:f TyPE G; Vif1,k vn04iEPA Arti'A CONST f;UCIION ,,f•FCIFiCAYION S
<br /> Ir•r'lur,tr+el (firm ftnitr•.{n ►A)r I,,,:a Elie (A Wsdt U.) of We4 c;•rai� j
<br /> w
<br /> Llor*)P.61if`f'r ivn U, , firavnl Pafl Tfary IYpa of CA14+ly,___.
<br /> Putsl,c 01har Dally Dopth of Gmu!Satf _- Typo iA Grow
<br /> IrnuaVon Appn)e Dr•i'R, 4na+nrrl Surface%*of lnatafktd kyv
<br /> fh•pnn Wn(l, Donn Tvpa of Pump N r. _ mato Wa+k Ou+'w _ _. _ _. ._. . ial
<br /> S•
<br /> r,tl D041u•_Gen Well Drar,4rrry Seal,nq Mahrrlal(lop',1.1') _ .___. ._.._ ._..._.._. __....__.._ ..-._. . . .ti) ,+
<br /> FOW Matnnrol I11#4)w 501 _
<br /> «t y E 1Jf SEPTIC Wp11K NEW INSTA1,01IONJ tirPAlfliADD1'tlpfl , L?FSTRUCUCIN r iNo MPIK a POM mtlr4 if ` �
<br /> P Y+l p'� jwtaii,:arra nr i.
<br /> av4tW14 within:CEO too!) t
<br />'i��`q, -.. Inat448h!f+ w,U en+vs riaeldnnra (',rnnrnnr+'rat a E)Ihsrr � :C'
<br /> NunHror of ivn+f) of 14,1jrunma r i
<br /> Chnryrtnr of and M n (irp;l+of 7 f,mt ,1,4 It, z;,,, _ Wmef tsbis depth
<br /> �FVTtC TANKr11eC A' Eyre Mri) eits Cal,sc+ry No. C(mf)artnwnts „✓
<br /> I*t,,%Ti1FAI Mi-PIT I T Ma!NrA of Dtspasaf
<br /> .ro A
<br /> (lialnru a In nan,aal W"1140 J�4 f uundat,nn /+l .__... Piviwny Una
<br /> r •T,Aa
<br /> 1 rACIONC, L INF No A`r k-fnjjfh of Inas
<br /> FILA17JI PIED U-atana a h,n,•ntetl Wwil r& i ountintim. vatry) P
<br /> i n>; line •.1
<br /> f.t6PAliF Plfq paprh 5•ra Nunuror .. I
<br /> A-= SUM{'S O,utance to nisi,+..t WpIl roura1ation _.-- _ Property Lina
<br /> O1`POF)AL P ONOCY
<br /> ls+g�rgpy f rrrtAy that I K014iva juvo;1ra014 frttrticatlon 41-10thlit Tire woth wal uo dor+a n+mewdamg wah Sen Joatiurn county Urdinarwe*. statu Erns, arv3 D
<br /> (VW Mudd raquletinns of it+a San Joagwn Lvcai Neahh District.
<br /> ffor+pa owt ar of ficvnawd upanl's sognl+t•rre 44flglul tt,s inllowin!f "I ra"ifv Ihal in fila jxit7ccmenca at the wink for which this pvrd1 ig i44itud. I,s;oii r,ftl
<br /> w nMoy any r,ws<m In such manna{as Ic becnmrr nuNict to worir+an's Cary enatrtlori wise of Cewvfmim.'•Contractor's hirinij or suL contracting s{g++atulo
<br /> crinifias the fosc wing-_"I certify that to the p irlotmancf+of the work fir which Me parmft M hwuod,I shall employ Porsom sub)at:t to workman'%compw lsn•
<br /> I,on laws of Celiforom.'
<br /> The appl„}ant m a rce�l{rt/jtlf rwrtulrstl)nsf skins, f;nn`frlein drswfny on rewrae iritis. ! '
<br /> ihjs, _ L. G�•.1..��...__�._...... ___. Gaff:
<br /> Lam-4(- r
<br /> { l r
<br /> FOR DEP/ANY'fro MY UBE ONLY �
<br /> �� r 7=- Q� �? Afea
<br /> i f
<br /> V.
<br /> Ap,licetion'Acc roc by I �.�{1 iL-Y1 L, ..�. .d`y^--.._ lista.--- Y
<br /> Vit or rico„! !nsunctiun by onto -__— - final Irdweewn by, `Zr_�../ One cLod
<br /> ` Addit{nr+sl Cornilwnte �!;
<br /> 'I.tui1 , 'I.' Msntoca tb,?3ltoa ().Trecy 0364AS
<br /> . A f+l,cgnl itoturn ail cop+ao to Er•vtrnnman+ar�crilh Parn4t/9arvM•as lftkit E. Haaalftin Ave., P.li 9os?0(Ai, 5M., CA G9120T
<br /> I N +iio L �MotJNI OUT.....". . .Amftigr i1i.MITlf'C� Rk:FfM 9y _ r DAT11 i M'dRAlti�riif Y +•
<br /> !`(It '� ) �•r 4� I� _. �..�J1�.Y?f-tt� j
<br /> t C'+
<br /> milk,'
<br />
|