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lir <br /> SAN JOAQUIN COUN'T'Y PUBLIC 1101LT11 SEIi'ti[_CES <br /> E.NVIRUNMENTAL 11EAL'P11 DIVISION 468-3A`�U <br /> 445 N SAN JUAQUIN, PRONE (20-) <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> PEIiMd'C EXP111E3 1��FROM UAT9- ISSUED <br /> (Complr�te in Tri{!.1 iCV t(-) <br />_ Appl[c+t[on !e hereby ande to Sen Joaquin County for a permit to colnirL'e[ and/or Inst-ell the vork herein described, This <br /> Application to hada I�r de.tiencc vlth Elan Joaquin County Ordinance No. 549 find 1662 ,.n4 the Hclea and RePulationl, or Sen <br /> Jrvtquln County Public Health Gervicee. <br /> Cllr <br /> Lot. `utxr./ACrcnl;c <br /> lob Address _ 1905 MClIenr,y2-Y-!1t1L1e _--_-•.-----_--- <br /> OxneryA': .+a ESC +LUSl paLkCr_.$- Address .-_..- <br /> SF1.CrcTIne.lCo Phand1f,1SS <br /> y;r3t 11rJ2stll!' Addfrss- 3233 Fitz�ertl.ti Licensetla. rt L ` 1011.1 1-1 <br /> - <br /> rnni,3tla1 -��� WELL REPLACEMENt fl+ DESTRUCTIt)N 1l P.it of Herrin•. Well CI <br /> `����NEW WELL (T r�i ER Zh Nonitortn8 <br /> TYPE tip VVELL1PtJMP: SYSTEM REPAIR L1Sni.l TJGriTI <br /> PUMP I'iSTALLATION 0 a DISPOSAL FLD---141 PROP LINE _.2-" <br /> SEWER LINES t <br /> _RC1-, -- r ?ITSISiIUMPS A�rl <br /> DISTANCE TO NEAREST: SEPTIC TANK n U3 j_apyr.ER WELL�3C1--- <br /> rOUNOATION _ 2Il t__ ALAI+;ULTURE WELL sl <br /> INTENDED USE TYPE Or WELL PROBLEF.i AREA C_Oi15TP.UCTION SPECEFI_ CATIONS Dia.of Well Casing i..r ---• <br /> Ltsnroca <br /> ---- 0%e. aT Wet'Excavation_..$�--- ---- <br /> 1 1 i -- GI Open Bottom 11 5pecificalions�--- --- '- <br /> AiKL1 Tracy Type of Casinv- .- <br /> Domenic/Privslc LT Gravel Pack Type o <br /> _Il J-�----- <br /> I I f GtouLElEct -�' n - <br /> I 1 Olher t'1 DOha Depth al GlOut Satl —3 -°-- - <br /> 3 I Public Surface Sauk Installed by <br /> I I IlnEletion 3U., H <br /> Appre"•Depth IX Eaitarn --�_� 1 <br /> .P..-�- Stsla V1ark Done__ <br /> Ttr+nair v;ork bone 11 Type of Purnp sealingtaterio,l i Aepth { <br /> Well Deviuction C] Well Diametera <br /> Depth !'.tier Hfe <br /> ateriel 6 pth <br /> tYPE OF SEPTIC WORK: NEW INSTALLATIDN 11� R 0`IIION I I DESTRUCTION I s aysilaWesupllwthin 200lootl,lad if public sewer is ^I <br /> Installation will sane: Residence_� <br /> Commerriel Othel - <br /> Number of living units: Number of bedrooms —Witter table depth <br /> Chsracter o1 soli to■depth of 7 feat:— Capacity No.Compsnments <br /> SEPTIC TANK 0 Type/Mlg Method of OkPOsal <br /> PKC.TREATMENT PIT.Cl Foundation P+operty Linc_ <br /> Cistance to nosiest: Well_ f 1 <br /> _ Total lengthlsize <br /> LEACHING LINE Ll No.6 Length cl linea <br /> FILTER BED C) Distance to nearnat: Wall <br /> Foundation rropeny Line <br /> _ Number <br /> SEEPAGE PITS I I Depth Sire -T <br /> SUMPS 1.1 Distance to neatest: Well <br /> Foundation <br /> Progeny tine <br /> DISPOSAL PONDS L7 <br /> I hereby cenity that I have preprred this epplicoHan and that the work will be dons in accordance with Can Joaquin.:aunty ordinances,stele Eaves,and <br /> rules and regul@lior of the San Joaquin COUPLY g•, that in the <br /> Home <br /> owner any porsan in such manna oaa to become tuho fl Ito workman i caympensstion laws 01 Csclorniehe ConMrectofor`r slhuing othis P s b contr cling signermit is issued.I leivae <br /> certifies th-?011Ion in i certify that in the become <br /> r1 the work for which this palmi[is issued.,ahsll employ;elsons subject to workmen's compensa <br /> lion lows Of Calilarnle." <br /> T1+s applicant use,c i for alE rad insPeCtian@. Complete drewiuq on reverse tidds. f <br /> i.w�i,psa� Title: e+1+ •iof of e*— � Data: <br /> Sipnsd K <br /> FOR OEPARTA'ENT USE ONLY <br /> Date Ara@ <br /> Application Accaptad by _-- Date <br /> Pit cr rout Inrpecllon b; <br /> Gate Finsl Inspection by <br /> , <br /> Ad-lnlonal Cair=rn@nla: �7San Jonquin <br /> ic <br /> onith <br /> nl,rlt+•nnr - llctnrn nl1 rnPtra iO' Enviroo—tal IlealthOPermi ;t/servicce ceet �. <br /> 445 N San Joaquin, P.0 jinx 2009, gtkn. CA 95201 <br /> .r.....-�-� CK RECEIVED 8V OAtE PERMIT'NO. <br /> rEE AMOUNT DUE AMOUNT REMITTED CASH <br /> baro <br /> nr tt M <br />