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5103739211 LOWE I-I2oGEOL <br /> - 640 P01 OCT 04 '95 10:05 <br /> SAN 4OAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> 445 N SAN J4IN, RON13 (209)468-3420 <br /> ,P 0 S= 20091 STOCKTON. CA 95201 <br /> } <br /> ES M D <br /> r {Complete in T Ip1� y <br /> ArrlieetiaM Is hereby a.4e to Sew J(XatuSn Count to- a .y <br /> appllCaLs,oa 11 atadt in c Y percelt Lo cane rue sad/ r ata t} nark r s a This ` <br /> Joaquin County <br /> compliance ell 8eut JoaQs3n Casnty 1 oa f sAd toaar Rlblie aZtr—&—" <br /> ea► <br /> Job AdQ(aii f4Z n. <br /> ....•••-- —� cr:y��??l 7.ot 3itclticrrage <br /> � _qOwners Nafrle � 'C � � _ Addles: f'�• � - <br /> �} <br /> Contra!1Dt t•+1 rAddresx —L-Cenit NO <br /> t/ ice • r �� L n.(.� Q... <br /> TYPE OF WELL/PUMP 444 WELL a WELL RMACEMFNT C DESTRUCTION L1 Out of8� eervice Well 0 <br /> ~ PUMP <br /> �� �•.Y������ INSTALL!ATI0 •� SYSTrLmrHoEai��tor�l ng <br /> *111NE <br /> "'n,101. <br /> DISTANCE NEAREST SEPTIC TANK 5(wFR LINES otspsAl L <br /> FOUNDATION AGRICULTURE WELLOTHER WEtt_ <br /> f i_rSf <br /> INTfN`0ED_ US6 TYPE OF WELL . PROBLEM AREA COOSTRUCTIOU SPECIFICATIONS 4/ f ( } <br /> t7 IndvernslT U Open Bottorn G7 I1Aanrrca Lara of W411f W411 of tpro o Wara Casrn <br /> f l tiOmesUCff1hWta C) Gr" Pack Ttacy Type of Casing._.. <br /> I 1 Public - >LOlha(h�i J n oetti Depth of Grovr Seal v TYAa a! Grou <br /> 7- - �..�.�.. <br /> I I {ur aupA Apflroz, be f I Eatterr. Surface Sour Instsllyd bye, " 4 <br /> Repelr Wolk Done Q Type of Pump f H P State Work done <br /> Well Desttuetton 0 Wall Dfarneter � sealing !rates ia: Ir Depth <br /> Depth 1*1110r YAterial i Depth <br /> I'E OF SEPTIC WORK NEW INStALLAT,10N I I REPAIR.-ADDITION I ! OESTRUCTION I—IIN* tepr+c SyrtOrn permuted if public itswer-+s <br /> avalla!)I0 within no fess I <br /> In'thIlAbOn will Wye. Resrdenco,r Ca'ftlme j iml Other - <br /> -Number of frying Vnits. 1 Numbw of bedroor ns <br /> i f e <br /> Character of toll to a depth of 3 feet, Wattr table depth ' <br /> SEPTIC TANK f3 TypeiMfy t . Cepaci , No Compertnrenb <br /> PKG fiREATMf:fJ'f PLT.Ll Method of Oisposal <br /> Olitanca to nearest• Well foundation Property Lille <br /> LEACHIN(a LINE Cl No Er Length of renes Y Total length/tire <br /> FILTER BEO 121 0 Distanoo to newest. aloft PotlndeProperty Line <br /> SEEPAGE PIT$ I f Depth Size --- <br /> SUMPS 4 J CL LI 01stanca to neerest Wall Fc underran _ Prorserty Lone <br /> DISPOSAL PONDS 0 �~ <br /> I hereby Certify that I have prepared this application end that the work wdl y 6w%z rn secoroance vsnth san.i0 ^ _ ---- <br /> [aquati7 CSS 91914 fowl;, er13 <br /> tules end regulations of the Son Josgv,n Caul tr ,�- <br /> Nome owner or licensed apsnt's signature Certifies the foao"ng "I cortily that m the perforrnaAce of rh• '`ry which th+e per r a •sued, I +hair not <br /> ensplaY SAY pattort Ill tush nwhnar at to b6co&A 4V1jaCt to"rkrn4n't compenaatoon laws of Cesrforn.e"C+EtO/~rgVI(0:ii.eilRl ect+nfl trpnatura <br /> certifies the folbw6w"I cantly that in the pedf'ormiince a(the work for which tr+.e permit w resued I,r.eu e o pe.,o,yl rib t to rk an s eornpenas <br /> tion taws of Calftr s." ., <br /> The applicant m cap for all r Inspectlone. Complete dramag on reverse side. ; E> E =,-�,,; <br /> $Ignpd r Tule / C£t7=SST , <br /> r I� Citta: .Of5 <br /> AATMENTUSE ONtr )V4 a !Az q <br /> AppticatfoA Ae4a tad b rW1n�C(It �, 154= Dole S <br /> t <br /> �r (trout Inspection by -Date_..,�_,._ Futial Inspect+on by Date <br /> Additional Con+n+.Al. __ .f- - - `I ) _ b�- 3Iyl__ _ .. .. _ __..._ <br /> hip)SaatrL rtVtVrh � <br /> 431 001sLae to Spas J004V1.n County Public Health Berkl*&e ` <br /> i EGriraar»ohtal Health Permit/Services <br /> l 445 N San Jowgtiiur fi 0 box 2006, lith„, CA BSROx <br /> opt AMpUNT Rra`tIT7LO - c <br /> ANT H <br /> INFO Z its cf,v av x� <br />