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APPLICATION :,)R PERMIT
<br /> SAN JOAQUIX COUNTY PUBLIC IIEALT11 SIACViCL•'S
<br /> ENV 1 RORK911TAL UJiALTU DIVISION
<br /> 1601 Y. RAZXLTON AVB. . PHONE (2Uk046b-:)4;A
<br /> • P O BOX 2009, STOCKTON, CA 952U1
<br /> PERMIT BXPIRM 1 YEAR FROM DATE 1 S IW ED i'�•.
<br /> (Complete In Triplicate)
<br /> Awliestioe is he by Relief to"a Joaquin County for I Pertait to construct and/or ir,su:: tr,e wort herein described. 1a
<br /> gwleat/oa is tee to compliance with tans Joaquin County Ordinance No. 549 end lb62 and the Rules and Regulations of f1an
<br /> Jstquls Cottsty ft�blic goal"services. � /1. C�
<br /> Jai A6MeN _-�L=Sd zr-t-�1— -r,K�__ � C,tv •L
<br /> rv~*$he"ttee�t... a�� L1,
<br /> ._Ly Ad**MCeAllmlet ll fsl- AOQ,esLf .F 1,"t Tw,its�.-lfl tI-le l .r ��• •. '?�� ��� L�Pnone_ �- _
<br /> TV04 Of VyELUPU41111, N14V VVELL :. Alt.l REpcAcit'li .T i T C hUN .' out of dervlce Yell L
<br /> PUM►INSTALLATION : SYSTEM REPArR114 OTHER 7 Monitoring Well C�
<br /> DISTANCE TO NEAREST SE/TK TANK SEWER EIN:S -. -_ DISPOSea TLD PROP LINE
<br /> FOUP/OATION ACRIGLTURE WELL _- .-. OTHER v.Ect _.. PITS,SUMPS -
<br /> 1NTENOEOUSE TYPE OF WELL PWMJIMAREA CONSTRUCTION SPEOFICATiONS
<br /> IMuegel — C:Open ba"oon (, Me.-leca Du of Well E•caran on D,a of Well Castrv; --
<br /> X►GowteeftcrPlate" Cl Great Pwa , T.acr Tree of Caw+q -- --_—. Specd,utans_ —
<br /> edeleg 11 Ouar 1, Dena Depth of Gfout Seal _- 7-os of G,94t
<br /> __Alas
<br /> �, Depoh I I Easton S..rfece Saws Inblalted br
<br /> Mteee Work Owlp _----_---- _
<br /> y> r/aefPutp �.g`L tr►
<br /> WM Destro ow D WM Downfall _ Sealing Materiel A Leyth
<br /> D§Poh — --_ _ Piller IhNrial f, Depth --'---
<br /> TYPE 00 SEPTICWORK NlW INSTALLATION I i RLPAIR ADDITION• DESTRUCTION IN, m-pr, s.sran perm,,..: 'uubbc sewer n
<br /> a.a„.t,• ..,mon 20U f,,vt I 1
<br /> Wotems en a/scan Rtweswce-- Cofh,•te,c.Y __ Ochef
<br /> Nuwlbar of Itwes upas Nuwlber of bestowhe_ ji
<br /> Cho,Kfst of sea M e Mfr an 7 foes _ __--._ - .-_ . .. V,u•, utile deptn _
<br /> UPTaC TANK Cl TppfM1Y __- CaWul,_-- _- No Cumpanmsnts
<br /> PIIG TREATMENT FLT El bletnud of 0.500141
<br /> Defame to nwea Wee --.--- FVyna1/•.,n (: .;.en, ,n.
<br /> t[ACHMG LINE No a Lenyth at Itnes
<br /> 1tR sED ;I Dwa,ce to newest Was
<br /> aatPAGE MTS Otsplh —. -- S,ee -- NumLa _-- --
<br /> i
<br /> SUMPS l; OeAan:a W neafeN Was _. fO..ndat,un -- _-- P•.,pwn, l.ry ___—._— ,
<br /> QISPASAL PONDS i
<br /> ,hereby cendr Met I hews p,epaas If fs appW.—and Itul the wwk —i W Qur,e M.a:Co,:w,•-.r n to ,sen J-j,,,,.n Cont,ordmancea. sting ja
<br /> futN and rEpaAMmne,W the San Joep..rt Cu ty
<br /> "o to o"not of l,cafged saw”•*"$,of cNUfels the Eosowry/ '1 can't,Thai,n tna ppr4.yr,.n.•„f t•• . ,. ty d.r..Ch In,i pit rrttl q,"Uod.1 U not
<br /> e,hoov MW person n WCrt trteftner as to bec Wyle subtact to wonmen a compsnua,on 4.-.s of..ar,4�,• f t ,,,r,.-I„,s•.,.,ny of sub conlifct”sognalunt,
<br /> Cpldya the lose" 'I cwwv Ines w,tan watrname of the woo►to,w'+,U+th.s perrmt ►sassed ,s1i 61.,, „error's r,utect to WWktnan s cc. nu
<br /> hon lawns of Ca tows'•
<br /> The 6060K rE can for as,epww pact Compr.4,aawwro on u.a.be sae
<br /> S.awlf / Tme — " _.. —. Date -�2Z/e Z r)i
<br /> '-1f0 PARTMENT USE ONLY
<br /> Apoin.aoen Acca~firms t' rt- -
<br /> +._�-..r ..-� sate Area
<br /> M W Grout 1ltsoatwo H Cate Erna.Inspection br Dud
<br /> Aeutbor*CWhfaema
<br /> 4*LICaatt - Nelt.rs all copies to. San Joaquin County Public Ne►ltt:
<br /> Services, ftviroomrntal Health Perzlt/Services
<br /> lfaOl E. Tleaeltoo Ave.. P 0 AoA 2WQ0. St,:cston. ,:...
<br /> w.f0 AaaOtMf DLI AttM}u.rT el MtTltO (,►5,t —NE CE,VtD Br-- —_---ATf PENMII NO
<br /> , ,�4w•,Ys, +17"
<br /> .,,.,4"y yfie a,
<br />
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