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F R."r l a 1 1 .r., '�L 1 15 F` .
<br /> SNA f SRCR lh1EN-vu Oct05 ' 92 10 -52 No OW F _ 1
<br /> P.ppLYCATTON t aSz'o i
<br /> SAN joAQUIN COLWTY PUBLIC HEALTH SERVICES
<br /> r <:� HF�V�Rf NhiC ISA HEALTH DIVISION �,��k A
<br /> ¢ N SAN j0_kQgj0. PROHE (209)468-3420
<br /> ' p O BOX 2009, STOt;KTON, CA J 520� ? FLA-��_t���
<br /> iOCT 2 6 1092
<br /> .OAt,O N ('X�0 N]y
<br /> pixlioaGioa ia-het`eby Pa ede,to San joaqu$m Cuuuty tar permit to ganetruat and/or Ina
<br /> /� ta �tKC f' a 'el��L�t��t±krUb' lri)t -6
<br /> Amlioatiots !a te■da SR GaerpY,laaca with San SoaQulrr Ga",Ly prdiranve 140, 5L4 and 1@6E and tha Ituloo $Ad ItcguLation4 of sLd
<br /> gaquta County MAI* X.-a14th 8drv.cee.
<br /> I broo � T-K _ r}T k0V t5,t-- S Chy 'L 4 Lct Size/Aarerlgt
<br /> JobAd6raLt 9uf(nrAoa �r1.1}GV'Ay
<br /> CIL [.Cx W r{ht Adtlfect: ji W Ia_ r4 Pho
<br /> t�wFt.r{NFI1na �/d yr ' .rx�.c' . 9 �
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<br /> Oonlrael. Add(esi #wlf;enae Iia._
<br /> YFI pF WELl11'UtvtP; fq—cw WELL p WELL REpLACEMEf1Y C'i DESTRUCTION CI Ovlf at" Servio4 Kel#
<br /> OT ER p Nonttorid$ Ifexl
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<br /> PUMP 1i�18'f�+LLATIOrr S�'S1 EM 1aEhala Cl t
<br /> f,21 L'(fA Olsm4 AL FLO_ PAOF. UNE 1�
<br /> 01SYANCL'TO NEAREST, 6€PTIC TANK t S�ft:ll LINES u OTHER WELL. PITS/SUMPS A
<br /> ••� - J - POUNOATION �` AOAIOULTUfte WELL.
<br /> INTI NOM USE _TYPE OF WELL PA08LEM AAEA OON$TRUGrION SPECI>SICA7lQNS If �u
<br /> O Y CJ Meng I)a, of Walt Extivetion.�® Gla. of Well calft
<br /> Cl Ifrtlttlilrial G pan �att6m i
<br /> TYt+e of G+atnC_ V Spett{tG441oni....—e
<br /> �.:,,! t':i Qor[IaaticlPrivata 0 orsvol rack 0 7F7CV - - o8 tt T/oaf[7 NrrF
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<br /> I 1 Oetta 04pth of Glaut 7Vpa of GraUt°'l public (�har
<br /> �f^rs �7Ut_ L7rtVyk
<br /> `'E 1 ! lerru■[rbn /LpfSl4K. fJprslh t 1 !#stern $Urf000 Soul tnsirliud bV.�.��•�•• --
<br /> Rdp*if Woo Dena U Ty"of eumP ,.�.-r..�- K.P. 6iaiR workDano
<br /> t?a111r3 }It tritl1 E DOP0 �
<br /> ::..?'�aN 04atruclian �} Will wtrrat;r .•,-r,....�.�.... �,.:17t,_ �
<br /> t`i�l.4r ZtLrrcar3a.1 tr �pti5 �--, —
<br /> WC I{: Til-W IN&TIf4l ATION 1 1, AIiPAIWADDITION I I GI STftUC I N 1 I iNa;i"t,t410 $ 6tt'n t3�fM""It pulNlc s,[rwrr is
<br /> f Ir>Ft/ItAttGn wltl■brVi Rbsi�iarri�fe T. l.Gt<i�hCiClai....� in 2 'l
<br /> other�-
<br /> t=- Nusrtb4r Rt liVirltf unit::..— }:u;,i�s of �rrtKcr:.._�..—.�
<br /> Water table
<br /> ChAC&C44r 461&ON 10 A tiapth of 3 1004, No, Ca+'rrpakrtn+anta
<br /> Mnt
<br /> gg"IC TANK 13 TypalMlp
<br /> Oapaoity.,�-.�
<br /> Malmd of
<br /> PKf3.1CfXHATNfENT PLT. OitGo4Ml
<br /> bi#tanas to rtelssvt: Well..... •-----•� €uUn+TaliOn..�,.-.... PrapartY Lim.,^....�
<br /> LEACHING LINE li Nc. 4, Lefigth of linea feral (angthlsirca
<br /> FfLYER �i:p 4� DletarvCa to Aa+r•d: well.�. Pcunuatian ,.,..�� Property Lura ..,.�
<br /> SEEPAGE plti5 It tmiath Sita��� Number
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<br /> SUMP'S
<br /> t_1 bIctanou to oures.t: WN, ._....�. Fbtl+tidar;an PrPPartY lino , -.-
<br /> DISFOSAL PONOS a
<br /> I hby Cdr'tlfy Ih1t I have prspesod this applitatlOn snd thsl the work w it h4 don* in eoC9rslanco wish &an Joe4ulta minty OrdlilarlCea, Mata Saws, enc
<br /> r futaa rind f"Uiitions of the gar+ la.cturt couhta
<br /> NpM�Owrc•r 6r 4ioanFsd apanl`s liAr►atvr4 44nifier It following; "t cerlifl'that In the p6rfbrmaftae of tn1 work Far tthictr this permit is lstzutrd. I shall r+ar
<br /> HorA4implQy"ony r ra k1*dliua ini'd"riar sQ u f 00Kfiorre aubles[ca workrPrrlA`t apmpef[ar♦tlan taws of Calilarnis," ConcfAmes hiring or gvb7-oontraatinv stgrratir�e
<br /> E_.g >iaf'lifisr<1tr#fpllo�+na. "I Cart}ty that In the partofmaFico 4t the work for which this permit is;Ocoee,t shalt emptily personsfUbPaCi to workman's G4rt�Penf4
<br /> floe uws 91 Colitomia.a'
<br /> ! r mrr ctlons. C.dit oaCe dikwinq.ark raveree fl a.
<br /> 7 h4 srpplirsnl m b # � / ! Q-
<br /> ned �,�... crate: 11
<br /> Sip :
<br /> OF-PARTMENT USE ONLY
<br /> ArOb
<br /> ::: ?ApptlCafi4h AOtaptad by Qf46
<br /> PU ar tiirout IMp+C[bn by
<br /> (?acs ,,....�, - �.-. Finei lm;"ctiOM bV
<br /> bdditlmsal t;Ommsnu7 Gr ti � �o�U1�
<br /> rr`� APt3�loiat - R4tt;�o at11 oPPie■ to; 8,n Jp4ggiA CO&t1+tY Patella HealthEervlce 5 t y
<br /> naviron 4fitr�1 I'`+a.ith Porm1t/5orwices (Fra ,1. �1l
<br /> r 446 N u ,+oIL4Uifi, P 0 Sox Gtkn, CA 98201 1 `
<br /> 143E AMOUNT _x FI�CfIVEO dv OATE PEAWT"Nb,
<br /> 1urSteNT I7Uf 9H
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