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<br /> APPLICATION
<br /> iSAN JOAQUIN COUNTY PUBLIC HrfiALTII $SRVICE3
<br /> MVIAONNENTAL IMALTH DIVIOTON ��� 2
<br /> 1444 N SAN JOAQ48
<br /> UIN PRONE (209) 8-34,90
<br /> P C DOE 20090 k' 109TONt CA 98291
<br /> PERNI'C j$ 5 1 YEAH Mm DATF. ISSUED
<br /> „� • ComPlete It1' Triplicato)
<br /> Appllratioe 1. WF4%y 116414,te .0 Jeaoutn eeunty rer a perost to eunatrvat •Ad/or inatall the 'veri barOta acncrs"d. Thi.
<br /> epPlfA,htletf if 11edo to Aatol,fa+ce vtth Bao deatute Cowy erdii, lore Yo. j169 .nal Ba* sh4 the 1N.lei and ft!£OmA000. of $to
<br /> imimAh om%ty Letltlle letL►A74 Cyrrltet. d ��//1
<br /> Job Addrew _110((. 4r_. Lam_-�1�,�.—_.h-�' — rCity __ �.�.\. Lot Mlce/AerCoga
<br /> OwnKa Ntma' Gt\R ' ��O J As Add"v Si..�..,1. d le•t+.�lti'IC`�t�{.� �_r��_, Phene �•r ^.i
<br /> LJ 0.4 f! $ •-aw .t. e C Qutf _ -j `1 9Id `
<br /> /f..•ll l I »t x•1.33 c 4AS�r•-�..,X oad 9
<br /> Aggress�AttS4Lltrr]e"�--.0 --- Lietnt_r No.� S Pho^9 64-4;_�?76
<br /> PTrr—0f-W_EtL1PUMpI r� ' NEW Wtk( O WECL REPIACEhtENT C1 DESTRUCTION O Out errerv,0i V�p
<br /> '� /UMP IN TALLATION D SYSTEM REPAIR CI OTHER �� .'Cnititulri ve11 Ll
<br /> DISTANCR TO,.NEAREBT: >IERTIC ANA .r SEWER LINES _ _ DISPOSAL PLO.,,_._ _ PROP. LINP
<br /> o0UNOX ION AGRICULTURE WELL OTHER WALL PITSiitJAtPe ._
<br /> INTENDEDr S{ , TYPL 00 Will. PROBLEM APIA CONSTRVGTION SPECIFICATIONS
<br /> G1 Inpvsuhl N vp.h dotterh ❑ M{nnea Ole. at Wetl E.r.{volloh OIA. OI WeA cotime .-,--.-•- -
<br /> 17.1 D00T%Itcl;1P1Ivete CI Grovel Pod 0 Tracy Type of Cttl^9. - Slxc!PeoYenO
<br /> i'I tubus Other tl Dolu beplh of Drom Stel Type of afoul,
<br /> I I litigation _.,Apo�t. Cloth I I Eastern Surlaco Sael InoUtrad by �..,..,.,,.�^.....
<br /> si Wo.'k DOOt U type of Pyma N.P. - „ Mute work Don. ..
<br /> Woo Da{tfuctioA O Wetl 011flytet Sea>•sna 114terlal • Dayth _. .
<br /> dipm ,•, : PL110T NPT9rta¢ & bapth
<br /> rP 1 RXi NItV IN TAk LATION I RPM" R p01 ION 1 I DERT CTION I �i� '�Itt .fie 1 /IIM s wit
<br /> In114I1064n wltl Servet 1111e1fideree ,'..,- CemmtrCgl ,_,.•• Other
<br /> Number of li unite: Number of bedroom[
<br /> Chorocnf el 194 10 1 440111 of! rut: _,_,._,,,,•,,..�. 07.;+7187�
<br /> —w— D
<br /> SEPTIC TANK., Q ' TtttelMr9 No. CO
<br /> PK G. TREATMENT PLT.O - APR f ��yLlpos►I
<br /> Dlsunle le noffeeti Well Poundation PeofTany L no
<br /> tEACH1NO LINM 01 No. M Lenolh of gree � T �. L HFAiTI �
<br /> FILTER BCD Cl DisunFo to nelU1B wen Foundation _ _ r IdHtiICES ,_.�._.
<br /> MEEPAGE PITS-^ I I•Depth , ,Sire � Number
<br /> SUMPS L1 Dlatlrce le Marell: Wen PcundeUon_ Property bine
<br /> ! 16POS. POy, - ,0
<br /> t nueby unity rhat 1 have Preperad hit,spollc.uon end that the work will be done In etcordenu with fon Jeogvin oovnry srdintnco P. 71!10 Iewe, ehd'
<br /> rUNt end %epuleflon7 of the}¢ion Joeuln covhty
<br /> Nonce oww Of fiolRasd eotht's'slDnstur4 (ki l;Pes the f0hOwlnM: "t eenify that In the porlormones of ant woA fa wNch this parrrll IE 1631,14, 1 shop ncl
<br /> employ any 11e1110n U such rAlhnor a to becetrs eubpci to w9ftman'e COrboenoo!lon tows of Celitorni/."COm1341ola hirl"or{u0-cpntFfCtln0 slMnitvra
<br /> 0orMila the fol in0: "I ear{'h•that I IN par/ormente of the work lot wh;th this permit 11 loved.I{heli►q,ploy Person{ Pvbfo6f to aorkm►n'a cO nPe Pa
<br /> 111A,4yA Of C111fotn1l•" i
<br /> The applicant must eel for il(rtpvir InfO�,etlen{. COmpIat1 dflrylhM,Nr ny0rla 1100, n
<br /> Sp^ed X Title. Dow
<br /> FOR DEPARTMENT LIME ONLY
<br /> 1t
<br /> application ,tctaprrd by _i Polo Ayes
<br /> '/ter 7rR'I,/,r-/✓,!,,T�/-
<br /> PII W Grout InlpeettaA By /,(��'�\' -� bre Pinel Intpectlon by
<br /> _� 0410rn
<br /> Additional Cementa - nF rr-..��''�L' yeltAl f_� �j LC•I-r.f•
<br /> k'f ApPllcant - Rhturn all eoPlce toi 91A Joequle Courcy publle Health Batvlc es J TL
<br /> fno,lronom"tal Health Pormlt/parvlcae
<br /> 441 N Man Jeaqulh. P O Box 9009, Btkn, 16A "?('I
<br /> ��'s[0 AMOVNT Out mo
<br /> AMOUNT R[MITTFD SN RFC[N[D OATE PlAmrT'N9,
<br /> APP- 29-92 WED 7 : 36 916 638 7276 P . 03
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