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j1E3EE9E57 TANK PROTECT SAC 994 P02 APR 27 192 15: 18 <br /> APpl (CATION NUA r1ii i L �.�► <br /> f*Gy�l.lt•r- <br /> SA$ <br /> 16A�J4A Y ��THESTI % $$ <br /> , AONgTAL PUBLIC <br /> DIVISION <br /> E8ELTON <br /> AVE. , PHONE (20040-3420 <br /> P 0 flog 8008, STOCgT(*r at 95201 Y` <br /> Complete is 2riplicfitte) <br /> Applic+cion ie hsr•Cy x&I W fie 400-Vi Cw*ty for • pQ�t to construct sad/or itutoll the "crit bertia d� ilbedo This <br /> Co�llaooe violSan Joequla County ordinauco No- 549 end 1862 aad 09 It"1e <br /> application is isade is a <br /> ►ad �► 0Ae ! San <br /> JoaQuln county public )leap? W09111 Lot, Si ie/AcTeefte <br /> .3 2� G S Cily c <br /> Job A444e86 <br /> b Address Z,r As�J Phone <br /> Owner"•Nam• �,4,L�zc_,4y (ilc) t Zs <br /> Llcenio No. '{ �0no <br /> C°"tf C10` ! WELL RlPLAC6M NT n Q�STAUCTl4N D W` °= swiao well <br /> TYPE Of WELL/ UMP: NEW WELL D OTN�R,� Ibaitorit� weu p <br /> PUMP INSTAUATION 0 SYSTEM REPAIR Cf ROP. LI� t�. <br /> SgWJA LINES _----- DI$POSAL F_0,� �S <br /> DISTANCE TO NEAREST: SlPTIC TANK �� OTNeR WIIL.�-- PIYS/6UMPS ,. <br /> FOUNDATION ...._.yr -- AGRICULTURE WELL ._ — <br /> INTENOED USE TYPI OF WELL PROQLGM ARf1A CONSTRUCTION SPiCIFICATIANS Di+ al Weal Csielf►q <br /> C1 Industrial Q ODef1 59119M O Haste Die• of Wean Esaewtian g�pifiaitloni <br /> Type of Casing <br /> t:l Dattasitc/Ptivett D GriYN Fick Q Try Depth of Grput Seel lyplt of Gr°`R <br /> 11 Publio Cl oih@f n Di <br /> Surlue 6eel 111111411111114 by <br /> i irrigation APPION. Depth I 1 E40trnM.P• Sett ortt Don{-•• <br /> Rap•it Work Done C] Type of Pump — f9e4liAi Ifat.rioi + Deptht'J/ e- <br /> 4 <br /> ww 0•struction d Weal Oiamegr _ - n11er misurtal i Dyi <br /> Depth y �p� <br /> TY [ Of EPTIC WORK: N!W INSTALU►TION I 1 REPAIR/ADDITION I 1 0@STRUCTION t f4abPR within Zap tremit led if pub4e waver 1e <br /> InstaWition wi0 asr": Rnodence -- ComrMrotl1-- other th t+t+t <br /> Number of OvMp unitsi NuMOV of 004r00nW • Water phis depth <br /> Cneractw of sag to s depth of 3 het: No. CofrP#nf*nte —^- <br /> SEPTIC TANK 0 Type/Mfg <br /> C�picity�---- <br /> PKG. TREATMENT PLT.O ��9f Diipoiil <br /> Oktsnce to M&Mt: WeE---- Foundetion f fpP1RY Lin! -. <br /> LEACHING LINE 0 No. i Length of lines Tote{length/449 <br /> FILTEA sED Q Distance to nearOsr Wap�---- Foundation _ -- Proptfrty llflt SEEPAGE PITS PITS i 1 O"th , Elise N4mbW <br /> SUMPS LI plstmKo to neereet: Well Foundetivn- Property Lino <br /> DISPOSAL PONDS QofdlMnGsf• Nate laws, and <br /> I hereby comfy thst t have prapared this 49Pikation 04 thet the wprk wiII be done In +ccordenOt Y41111 000 J999441 iQyn1 Y <br /> ruNe and ret;uiatione of the Ssn JO#4uin County <br /> 1 certify thea In the pertormance of the work for WII thio Permit k issued• 1 no <br /> Home owner or Oc in*u agent's (as to certifies the 1 to <br /> ' signature.mpwy any person in such manner as to become wDi1K to workmen's compenNtlon lane of GOforrtlta•"Cootraotot's hMing w wb•conuwtk+q ai9n <br /> canifiae the following;"I certify abet in the performance of the work for which thief pero'►it Is lsfuetf.I shoo smptoy Persian{e4014KI eo waitmen's compenaa• <br /> tion laws of C411focnW." <br /> III The apptican t call for it d MfPf?ctions. Compote 4rewfnQ on reW�10 iWe. <br /> U a-r-IBJ /V•u'Ro� Det.: -- <br /> Signed Title: r <br /> POp DEPARTMENT USK ONLY L <br /> Area <br /> Applkatlon Accepted by <br /> Fit of Grout Inspection by �1� ^`"!�— - Date `// 'L CZ Finel Inspection by `` Date <br /> ,ddhlonel Corttrrnnts: <br /> Apyliorl - Return ell copies tot $ea Jottglx1A Couaty Public Hrtslth <br /> f3eryiecli► Saytrott+wotal Health rerteit/Services dU <br /> 1601 1. Aeseitoa AW•. P 0 )ox 2009. Stockton. CA 95201 <br /> AMOUNT OU9 I- AMOUNT A6MITTEO � N Alcolvl0 NY OAT$ PERMIT NO. <br /> all 13.24 1111.•stINfO <br /> O_0 '0 <br /> tH t.•» ' <br />