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<br /> WIT SAN JOAQUIN COUNTY PUBLIC 88ALT8' MMVICSS
<br /> oAquix, PROs ce3468-34.a0
<br /> + X18, BT TON* SCA 98,201
<br /> (COMplete in Tripliasta)
<br /> AmuiE►tdop is ttirsi3dr■ids t,0& d nfa ftmtr tors peftit to eanstructi`' aakVof' �ARt;R1 i t:it troir; Istt*ttn ditiarib#R..
<br /> iL3oit.Sott ► Rpt t+t:. 2tR KtN;i;;#tsu 1btgvEtta ccuaftr ordinance Ira, �k9 trAd ztl62 and thr.;lhttaa +Iad..fts�... If
<br /> �' usi xii sk Ili)eVsiiiy iE1rrR�LtAOs;tiT ttlR1=;
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<br /> 7"G`Job Addiroal
<br /> —Low s�st 9tttrtl�►trt�� Q::��`�`��:+�c�-e�
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<br /> 0~2M"IQZX 12/ ' "' rS!
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<br /> Atldrtst + az2/9� 5„ sit„64 G4 f'13 hroe�R
<br /> contrilaWN&US 71#61
<br /> TYM OF W tR/PUfi�►. NEW WELL WELL REPLACEMENT C1 DESTRtiCT1QN
<br /> Pump WST�tf;�/1TtOtV U SYSTEM REI�AIA Cj` tiaa
<br /> I DISTANCE�'0 NEtttTt OTtERAa © c
<br /> 81<PIV TANK. 9EV5tl�►t UNEB G 5O' !V�
<br /> «r.i..r+.,.r..i,,,.. �?t8PC9AL icl0,�,:.r.,,.,... PROP LIME.�.,.y ..
<br /> FOUNDATION r"'`' ` .,,.,,..:AQAtCULTU11E WELL Nd t�THLfi WE6if..�''"�..,� P��1I#AA�.. > ..
<br /> INTENDED 1l111: TYP!Of WELL. FAMEM AltlfA OONSTRUCTION SPjCIPIC.t TioNg
<br /> CI Indus IN 0 Opprt uttom Q Mwmaa bit.of Wett iltRavt
<br /> DSI+of t�GiitiE. ,
<br /> tJ tErlvlEfi _, Gw*Ptak 0 Tracy Typ!of Ca<
<br /> I'I t I:i:t Mir n Ckrttai L"itptlt al Grou Eett A'7 ?1 + t
<br /> I#t titan Approx. tett+ t )Eastern .Surfs"Ust Inswitadjby4aylc
<br /> 11100011,Work onct Typo of work Done 1 _
<br /> lMWwl[ariwctra tl
<br /> O VYeE g4reater ww,,,,,r,_,iff�. itrtar:.�. � �� '�
<br /> . ._ ruler xas�.ru�� ,i�. � MINT
<br /> WTIO WORCNlESN iN#ITALt,�4T>OfV t 181FAMIMOSITION t 1 OESTRUCTIGN I i INN toplic tYtrtt�
<br /> ' t I evtNacde rrltttkt f + #t
<br /> +►ilf tort; Residence
<br /> APR 14
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<br /> ......... tr+hlnttr of boast : - .
<br /> ftv=W Of W 90 i;diplh Of S Sf+ttf J{}JUIN r .�..STT
<br /> +.... ...
<br /> wilor 1211W41MIG
<br /> Rte TANK. Irl TppeJlrifd C etc #
<br /> No. CC
<br /> P$G.TAEATIAW M.T.Q Method of fibposRt
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<br /> ftanottoftwow wtE POttndtti0rt;�.. . Property
<br /> �LEACtdi#NG UNta Q Naf A of lh+as Tenet Is /fix
<br /> KTO AED Q Dittance to nearest. Welt foundation
<br /> ftoomyr Line......�.......
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<br /> tiJls3E P#T8 #I DiPth 8ktr NuntbRr
<br /> t K1IlIAFK Ll Mow ci nw"t won, Foundation .,,..,f.�:.r..f Al"►rly"Lift,
<br /> DISPOSALfON[�S O ;f! ......,_.f.._µ _f. s;
<br /> booby�tltitt I have prepared 1w tppGeation NW that trot w0ait wlk b0 done 1n aceord rlet with San J010%tountY ordinances.state laws. grin 3
<br /> n4ft am rt` kotiottR of till San Joaquin Lowy
<br /> e Owtstr or litisttd tpRrtt'R RfEnttaare otrtJttet the foflowitlp:"1 t;tnlft ttNiit in the pePat
<br /> of the w r fg(
<br /> �thy'PITil"In such mar 4t Ri to b4CW subject t0 t�rorkrntn'�t+CStMpetfgttots lbws to
<br /> FAN
<br /> Gtttftti if1R foiowtnp:"I Cirdfy this 1n 1ha porforrnW1#Of tits work for whsoh this permit is Iit4
<br /> kin 111.4e Of t+iEtofNtr
<br /> ttont cortiow drawing=C" Sld SpE71r+1ii Sl r-
<br /> $4�: ���... � .. ...... f/!t*i � irm f fn r� rnrfrrwr•t�tii
<br /> FO bEPARTMENT USE ONLY
<br /> ry
<br /> Application Accepted,by. Dire �f Areazm
<br /> Pit or Grout Inspection.rfy at
<br /> 'rag- Final In
<br /> r
<br /> spection Eby
<br /> additional:Cownents: '
<br /> Applicant - keturts s23 Copies to; Han Joaquin County Public Health Services
<br /> Environmental Health Permit/8ervi4
<br /> e9
<br /> 445 N ,San Joaquin, p,0 Boa 2009, ttkn, CA 9520].
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<br /> tiVl�. #FES itAtitJPtT ttHE AMOUNT REMITTED CASH RECEIVED 9Y OATt l►ERMiI'HQ. i
<br /> tiM t19�fAtV,:tlfle� 0 7f.. f ,.:, J/ /�
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