Laserfiche WebLink
SAit •'76QLTT2i CJmr-'Y PM LIC MALE —1=1= D �� <br /> b'MIRCKI MAL EELLTM DIVISII-. T <br /> 445 h SAY JOAQUIIi, PBONE (209P�3&20 <br /> P 0 B= 2009 , STOCr7 <br /> r r 1 _ <br /> I ^—IS AP EEON DAA_ _ - <br /> (Compleze :z Triplica: } 1 <br /> INS � <br /> Arj:leatit>• is ierew m"e to San .30eQu1s Co=%v to- a pers:t to cmxwuct - <br /> syy2Sr:aLit� is I ade in emiplianee vitt ban )C%gttia county OrG_naaCC ko 5L5 alit 1662 aaL the Rules risie hegulatioms o: baa <br /> aaquia County Public BnaJ.t.t Services <br /> Job Areess U��rcr% �tQ Gny �� aw Lot silt/J►crewSe 1%� "(_ff t– <br /> Owners Nana l,�ro+'t C+o,gt7oress .2,q(o Cas,,,1n:= rt` cLw_", �kGr'S <br /> Gontraclor 5Ll/ Se1I � ass s".7r So�,4.I..a_� t rc, C6Lrerrse � 7f �" <br /> -r <br /> TYPE OF WELL/PUMP NEW WELL WELL REP.ACEMENT E) DESTRUCTION ❑i Out b: be-vice ire1Z L <br /> PUMP INSTALLATION D SYSTEM' REPAIR 0 .! 5�.�/Te•,�•�THER� Nonitoritld Hct y� <br /> DISTANCE TO NEAREST SEPTIC TANK SEWER LINES ikC 1w,67"' DISPOSAL FLD PROP LINE <br /> I:OUNDATIDN AGRICULTURE WELL OTHER WELL PtTS/SUMPS _ <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTIDN SPECIFICATIONS <br /> L1Inouatrtal ❑ Open Bpnom ❑ Manteca Du of Well Excavation >� " Dm of Wail Casing u <br /> )';Dmrev <br /> oetctrc/ 'at" ❑ Gravel Pact C Tracy Type of Casing - 4� C- Sp*Cdreauoru <br /> I Z Public r T 1 >p-OtrwPloorTD"r m Della Deptr o1 Grout Seat rL'J �C a(-S Ner7-ct-. [r.,n� <br /> X11 '\ 1 ypr of Gnosis_ <br /> I I irrigation jt` Approt Depth I I Eastern SurfaCs Saur Inalished by <br /> Rep-Work Done L) Type of Pump H P State Wom Done �N 1 I •—rT4,4+ ^%b-6: 6+ •V- ►.>ej� <br /> Well DanruCt.x+ ❑ Wall Diameter -=• &sAlit* ►*ate-Lal i Depth Oen a Nc�.T C. �a�fT ( r) <br /> Depth 1t�bsr r111e- Ats.e-!al a Depth, 5�..4J` 20 I'a�1 L?- •1 <br /> rcr� s <br /> TYPE OF SEPTIC WORK NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I I INo "pl¢ system oarrr,rtted if publi. Law*, it <br /> availabte within 2m fee,p <br /> Installation wd!so" Ree+aertcs_ Cortxriere,a,— Other <br /> Number of trump units Number of be4roorrtl <br /> Crtiaraclaf of sok to a depth of 3 fae, Water tabes Ceeptn <br /> SEPTIC TANK ❑ Typo/Mf; Capaerty No Convartments <br /> PKG TREATMENT PLY ❑ Met <br /> Distance to nesmv- Well Founaal*n Property L4�i v <br /> LEACHING LINE M Nc b Length of Inner Total Ieng1h/scir� �r ]`l 2 Q toC-3 <br /> tip._ .... <br /> FILTER BED ❑ Distance to nares: Wel Founpation Property Line <br /> tN�TrRU7RENITAL HEAL T H <br /> SEEPAGE PITS I I Depth Sue fvumper . flrRTe- <br /> C_-5 <br /> SUMPS LI Durance to nacres Wel Fourroatron Proo.rry Lira - — <br /> DISPOSAL PONDS D <br /> I fief*by eerttty tha' I ha.g pret>'areC thn applet.aiion ano Lha the work will be Cone in aeeoroanee wain San Joaourn Coumy otainances state Low, Ona <br /> svIet and ropulirteora of the San Jo6ourn c4XLe4v <br /> horns owrwr W bcenaeC agent i twghalurs Cortefrez the IOAowiny I Certify that in the pertDrmince of the work for wrlieh this permrt n raaued I "if not <br /> ofttOlOy any wraan in autA Rfanner at {p be,c ya i,DOV 10 wimman i Compenuleon L&VA of .ralrtornrs Conira:lo i Rhin; a sut}C.ontratlrrK rwgnolure <br /> GrRrfrst fix loipwv r Cartrty try•in tea per'irxnarice DI SM VV 06 for wrlri:h then perrrml is cmueC I shall employ persons subret:t 10 wora•r►an i =mperW <br /> Ocin Low% of "Slorrya <br /> I <br /> Trx aOWiun1 frail cut to ar noueec�wup.ct,ona Camp+et• crew,np on rewrar coos <br /> Sgned �f C..� C Tlift _j_ <br /> Date <br /> FOR DEPARTMENT USE ONLY ^� r <br /> Apd+ratrah ACC <br /> e+ate[ by Area <br /> Pr o, Grow Inap*Cjeor, t>y U Datel Friss Inspec=tion b} Date <br /> Aadnwna! <br /> APplieebt - hetu-n a_; copies to Sit JaaQt,L Courtr ?s .11[ Nealtt Se-i]teF <br /> LrV.1-ontaertx: healtt fereSt/Se��iter <br /> t 445 A Sat Joa4c.St P C box 200Q Sttz CA 45202 <br /> FEE it►tDtlid- <br /> INFO NT PVI I AMDURE&A TED CCAS" RECENED t- DJ.Ti 9ERM17 kD <br /> I�, j <br />