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r a, t t <br /> APPLICATION Er <br /> SAN JOAQUIN COUNTY PUBLIC ILEWWH SERWICE4 <br /> ENVIRONMENTAL EFEALTE DIVISION r� <br /> 445 N SAN JOA:jUIN, P20NE f2MzJ63--3420 <br /> P 0 BOX 2003, STOCXTON, CA 95201 <br /> 1T,. 1 YEAitFRrik! DkIY <br /> (Complete in <br /> App11cat1nL Is huretry ■ade,to San Jc_iuir. Count for • ' <br /> S y Perntt to csna true? and/or ir.ar�L' the vorn `++rein dcc�ribed. Tnss ray° <br /> arpllcation In me* Its earvpliance vith Sao Joaquin County ordinance No. 51'9 ane. 1862 and the Rules 71 °rquJatiG.SA of sail <br /> Joaquin ':oAnty Public Healtis Services. -., r <br /> i r <br /> Job At+drear L -G-- f.-'--K1,3MF _ Cvy./`- •7'r. /ai-/ Lot S1:eiAcreeger���l���•�l� a,rt <br /> Cwnee't Name s - -- - -tel-- I / f -t!'.�"� <br /> ^���fr.,.. J�,���: Adtlrl-ae �i-�.��,,..�..»ll•J-11.x. phone <br /> i.� <br /> Lam;,attd:4:&Qr �'-ry Y Address � _ F- y5}�Y��e . Plane <br /> _ _- Llccnse No. ,�„ <br /> TYPE OF WELL.'PUMI': NEW WELL 0 WELL T41F'L,4C;MENT f'"i DESTRUCTION Vr Out of 83rvi_s veil ❑ V <br /> PUMP INSTALLATION C SYSTEM RE°Alit 0 konttcring -dell <br /> _DISTANCE TO NEAREST: SEPTI'TANK __ SEWER LII:ES; G'SPOSAL FID. �� PROP. LINT: �. <br /> FOUNDATION_721 _ E.GAICULTURE WELL OTHER W-LL-2!�L.:!2_ PITS/SUMPS <br /> IN1ENPED'JSE I!_P:_OF WEL1. PAF6t3� CONSTRUCTION SPFC!PiCATlr7r'tE Y r; <br /> C)!nauatrral - -- 0 Open Ooltom fS ha+nzaca Die t.'YJelf ExcAakinn�1�rT 0u, of YYsil Casing <br /> fl DomaauclPrrral• VGrarat Pack ❑ Tracy T-,�a or Casing_"�- �4`I SFacificatwna� <br /> i•i Pu0c i"7 purr fl Offis Delith of Grout Seai ( Type &Geout`.,,F', •el!'!/jam r ' <br /> I I Ifugaleon _-Approx. Oapih t r Eastern Sv;lace!ieul intiallsd br <br /> Repair Wort Dane L] Type of Pump _ M.P._- Stale Wank Lone <br /> W,14 Dotintc[iat 0 Will Diameter _ Scallna ka.teritl S Depth <br /> Dspth•__--- llilrr FFwte:!a-1 k 1>rPth <br /> TYPE.pF SE�'TIC WORK- NEW fNSTAt.L47tCN f I R1PAtIArgnpITIJN—11 pESTA:;CiIGN k I Iglu sapuc sl-.!Gm porm:ned if p�tp!,t arrwor Isla _ `' <br /> aysdable wtit^in 2co ivel.l '.; <br /> �� tnara:laf'on will carve: Raaidenea,},•_„ Comr-arc:rrl_ Ultier �•\ }� <br /> Num-ef of living urita: Number of bedfooms <br /> Character of sed 14.4%60th at 317at:—_ —Watar table Depth <br /> SEPTIC TANK 0 Ty%viMfp Caprslty Na.Corn,armorta <br /> PKG.TREATMENT PLT.0 ;rlelhod of Oizpas3l �:- <br /> Di:iancs to vastest: Wait Foundotion Property Line <br /> LEACHING LINE D No.A LenMh of tinea Total!an r/siz^ i� ' <br /> g� IL <br /> FFLTER SED 0 Distance to rae•aat: W011 Faunda;ton _— P;opnrty G:,o w. <br /> 1 . <br /> SEEPAGE PETS I I 0401h -SITe NUTD3r <br /> SUMPS L1 Distance to neama;: W" Foundation Proplirry,Line <br /> 6lSPO5A! PONDS 0 <br /> I here-,cavity that 1 have peeparrd this epWicatton and that the work will to dor.-in accordance with San Joa4uin cok my ardrna,'mes.star/laws,an ' <br /> roles and roguiattons M the Sar Joaquin County '''��fVVV111 <br /> Mame owner cr hcanwd e9pni'a"nalure mttifiall Ilse following:"I CerWY than in the D,ar)otmanca of the work for-Much%his perrrvs is=uja d,i xh:il pot <br /> ismoloy,any perlan in auch nwrar as to beca.'Tra wblect to warkmen's cw p-nwtar.lawn of Catilorr.+a.' Contractors faring or aulrccntracting ugnoture : <br /> o9114ies tho 103cwirtg:"I cenrry that in the paAyr.Tanca of the war.,for which this permit to issued,I Snell■rr_!ay persons subincT to wwkman-•corripsnsa. t° <br /> rico laws dl C via." E' <br /> 7ha a E m t cau hx 39 r Ked inq eG a.Complete drawing on rovarae Aida. <br /> �i <br /> S+prlad �'' Ttllr: J <br /> ' pats: o <br /> / t <br /> �} FGR DEPARTMENT USE ONLY q o. <br /> AilplicatWn Ac..'a0r6dby _ patty <br /> Pit Of Groat InSWI10t,b, i -' Data__v _ Final Inenpetion by e A Lr Oars 4)f - 2- <br /> :4dnzartsiCommanu: � i�� ��._-._ :7 <br /> Applicant Rett rn all copiae to: SAA JaaCuin county Publtc 11naith Services yy <br /> Ec.vironnontal realth Perm:tiSorvitee f^ Sd F <br /> 6=5 N San Jcasquln, P 0 Sax 2000, .,tka. CA 95201 F. <br /> `�a AF.tDUPrT IIL'a wMO;JNT Ai MITTiC tK a R°C[ryED ar OATi oeP1ht:T"NO. # <br /> I IElt) C A$M , <br /> i`*tar .a.r00 <br /> s <br />