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SENT BY:9163622318-Sacra. , CA : 8-16-98 ; 9 41PNI :RADIAD INTERNATIONAL- # 2 <br /> • APPLICATION <br /> SAN JOAQUIN COUNTS! PUBLIC HEALTH SERPES <br /> g1VIHONmTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 <br /> P O HOZ 2009, STOCXTON, CA 95201 <br /> PERMIT EXPIRES 1 XW FROM DATE ISSUED <br /> (Complete in Triplicate) <br /> ApPlicatlonis hereby asde.w lists Josquia County for s permit to eoaetruct and/or Swrall the vork herein described. <br /> Sots <br /> mpPU,a,Uen is made 1A Coepllance vltb Baa Joaquin County OtdlPspcc NO. 519 mod 1662 nod the Rules sad Re8 <br /> jimqu1a County Public Health Servi�ces- <br /> O C�.SS OL.F '�'S Guy I Let SSxe/Acre <br /> Job Address age <br /> 55.Co �.W <br /> T <br /> Fe,aY Ade exW IDAD gLA6. 2129 <br /> wPho�°�-erg-7aYir <br /> pna/s Name <br /> LU,,*_ Address TtiG n <br /> Contractor <br /> License <br /> TYPE OF WELL/PUMP NEW WELL 1lEAli� WELL REPUCEMENT yDESTRUCTION Ll Out of 8ery1ee Well LlPUMP INSTALLATION ❑ <br /> Sr STEM REPAIR ❑ C6100THER IY Nonitorlbg Well ❑ <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE — <br /> FOUNDATION AGRICULTURE WELL OTHER WELL PITS/SUMPS w <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS 6rckrEHCH10 wo4r-RAAJS) <br /> Cl.lnatsmai ❑Open Bottom ❑ Manucs Die.of Wal Excavation Dia.of WIN CpMY <br /> n DorheeR;/Private ❑Grant Pack C Tracy Type of Cawq_ SpeoAicatiers <br /> i'I Public 1'1 Other r. Delta Depth of Groul Seal Type of Grout <br /> - <br /> I hripbnrn Am". Dapth I 1 Eastern SuwaCe Seal Mnalled by <br /> Mpok wait, own ❑ Type at Pump H.P. State Work Dora <br /> Wes Dowiruetton n Woo Diamete Se+1=nR wterlal i Depth <br /> Depth tiller Material a Depth <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION I I REPAIR/ADDITION I I DESTRUCTION I l INCcsys'emm Permitted it pubic seat le <br /> InelNletion vws verve: Rveder _ Commercial_ Otho <br /> Number of Woo owls: — Number of hardeners, <br /> Character of wit to a depth of 3 tat: Watt table depth <br /> SEPTIC TANK O Tyle/Mfg CapacAy No. Compartments <br /> PKG.TREATMENT PLT.O Mothed of OmposM <br /> Dortamn to merest: won Foundation Propany Line <br /> LEACHING UNE ❑ No. g Length of limp Total Nnoth/site <br /> FILTER SED ❑ Distance to nomme[: Was Founahor, Proo"lire <br /> SEEPAGE NTS I I Depth Site Numbs <br /> SUMPS LI Pistsnra SO r t: WON Folndo ion Property LA,-_ <br /> DISPOSAL PONDS O <br /> I hereby certify that 1 have fpwamd this application and that she work win be dorsi m iccadancs with San Jnagnin Coumy woolli teas,atsM laws, and <br /> ruin and regulatbM of the San Joaquin County <br /> Home owner or lw4wd d wpm's s"IV,osmIm the foaowi,g: '1 esruty that to the paernc <br /> Horme of the work Ea which this permit is Asuod.1 shell not <br /> erso <br /> "Ingy any Person it,such nonan/o to become subject ate—li"A'A compensation levee of California."Conbanto/s hiring Of WOt tMtM9 elgna/UM <br /> "mfies the losewimo:"I certify that in tha Performer 's of She wok for which oto Permit is issued.I"employ Peraew aubjan 10 wcfkman'e co ponsA <br /> _ bion ben of California." <br /> The apphGm eau for req iced Mi etiow. Complete onwrl9 CAA-ra errve$ides <br /> silP»d ride:/s: �I"aE'CL1 /T O.Ee• y <br /> o FO PARTMENT USE ONLY <br /> Appcatmn Accwtad by Date 2 AmAC Ul?-AvSCXI-(� <br /> Pit or Grout Inspection by Oats F!f`at Inatrecuon by Osa <br /> Additional Comment$: <br /> Applicant - Return all CODS a tat: San Joaquin sty Public Health Be ea <br /> Eovlroosentel Health Perm4t/8ervlce6 <br /> 445 N SW Joaqula, P O Bos 2009. Stka, GA 95201 <br /> EEEAMOUNT DUE AMOUNT REMITTED CASH RECEIVED sy DATE PERW7 NO. <br /> INEO Page I: <br /> On FC pO V Irl 4F4--- <br /> Ea r61s <br />