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.F Y•ll <br /> APPLICATION FOR PERMIT - <br /> x: <br /> SAN JOAQUIN COMM PUBLIC B=TH SERVICES <br /> RNVIROffkcWAL HEALTH DIVISION <br /> 1801 E. HAZELTON AVE., PHONE (109)486-3410 si <br /> t <br /> r <br /> P 0 HOZ 1009, STOCKTON, CA 85101 <br /> pnDMIT EZDIRE1 scan FROM DATE ISSUED W-1(ccenplete Sn Triplicate) S+,y <br /> Application to M»by each,to sen Jo,4uin Comq rw a paralt to construct .nd/or imtall the wrk L.rt1n descri Im a y' <br /> applleatlN i. node copllon" ulth Sao JoKuia C000 y Ordimta so. 549 Pod 1862 sed the Rotas aed Raplatl <br /> teu OC sN s <br /> JNetris Carty Publif Naalth servieea <br /> Mse <br /> Jot AddnN �..� 1�,,. l+ . 4 •,..,o���� CNT N'Lot site/Ael' 1 ,, <br /> I � <br /> owrw's Naas � -•t.� cF '��o<tj ti..t Add.. O /Y vt-ry-A. •LC-,at„�•• '�•ii.frl ,herb <br /> Cmttacta Addtest'Zt''1 � P.�ra'..}.r�� Cwt License No.Lil-Yc+ tiPhone L <br /> Y Pt OP W LL/ M NEW w[Ll Sir OESTRUCTION Q dlM., iN , <br /> i DTN[R O h` "Falls: <br /> SYSTEMneli.i <br /> PUMP INSTALLAMN O PEPAM O <br /> OISTANG[TO NEAAEST� SEPTIC TANK SIWU OctS ".DISPOSAL►LD lMOLI9IS , <br /> FOUNDATION AGAMUL"WILL OTHIR W[LL ►1T1/SUEMS i'—t'I " ,7t x ',. <br /> TV.WED Use TV"OF WELL ::MOSLEM AMA CDNSTRUCnON SPfVl`lCADMS I eft <br /> 'i Well tteawwn 'v.]' Die,orwo eflf0, <br /> nIrrdumbl .: Cl Own swam -CI Menlo" '- ":T.DIa, <br /> f1 Daluwln/Pdasu - 0 DIM Puk , ' `:17 Traq Type of Clain �W — <br /> I"Velioll <br /> T <br /> - not Gbut *� <br /> t'1 Public I 1 OtMi;x f'f Dohs <br /> yN __Awfoa.Dwh tft"i" Sudeco Sad(mJ <br /> Reps.woos DEng U r TV"N PYRb I C sbb we A Ome A <br /> DIlNb1 +a• @mum fb4ltal A ORPUL <br /> Was Daetruemn a' wM , -nllr YAMPt L a 0117th • ' <br /> prop, fsy am%: <br /> Y I I ALLA i R[ AIRIAW 0 I DjjtAUCYlON I I INe 10011E Irwan pe led d Pm W"Is <br /> eraeahla wuha IN 191.1 <br /> Iltataallnfl will rNYr.. RoodenEe— Ca�frdbreW Delve <br /> N~of"mall:__ NnaEaf M tedteaPr wool,tam depth . <br /> Ch@ MN of NE W a depth of]het: No.CaroamrnN <br /> SF.PM TANK .,Q :TWO" <br /> Method a OMpeul <br /> pKG.TPETATMENT PLT.(3 , 11YM - . fhopsnY line �• - <br /> DWarc*u n.a.aC �. <br /> ., . Taal W19th/Na <br /> LEACNNEO iJlR - O No.E Lagpl at am �. <br /> i1LTER SED O Dtarloa ro net~. Was Foundation P'ow tv Lim <br /> I� <br /> SEEPAOE PITS . I I Deph S1w <br /> NuR,bo, <br /> LI Oltunce u Podiums woo eo i illation_ Plop,"tsb <br /> siRAn <br /> DISPOSAL PONCS- D <br /> 1 hawbY fandY that I hM pooled RW Wlft Mn"A INS ala waa wd be Oab h Kcdrdallce.1h San J0441114-CaHHY adRalcea,Me"fnaa.""d <br /> RAss ar&bpMee^s of the san.beadn coanqp <br /> ( -/t•".- <br /> at nN <br /> NVM Dana a EesebW asaR's alpnatlle randNe 1h;Title.A-W 1 CW*Y thet M 110 OsAalrvece worY br w11kh mi. almM is"Ad.1 shoo 110 <br /> eTply/ah,,puann JI such nWrlNr N 10 bacana d~b co <br /> wpawlaYs ni orlaallon laws a Caafontia.-cmirwoes heap a wtpcMtti "etnnws <br /> wldflaa too I ahem <br /> u EeltdY that if,the palfalrreKe of too waa b w1Kh this parl+t b iaund.I moos arll0loY psla0na whlM ro+1oltRla�s co111pe1ar �. <br /> tw„•era of c uawr <br /> The apOhclK num tall ret N booted hEpsnpnn<Collgiela dlewirb on IeY.rr millet. . <br /> L - Dab: <br /> SWad <br /> POR DeIARTMENT Use ONLY ) �/ <br /> AppaulroRp4 vea,w ..�. S Dau <br /> rot wo, <br /> e =\tdJ dTAn <br /> Applicant - htura all tot goo Jcegele CountyPuhlle Raaltb •J` �GJ Ja't <br /> l S Y.aalt veno strsn sarYicve. mor ireeacr+l sealth Pvrvdt/Serv1eea G 95201 KK <br /> L dR a uq J 1601 s. sarlty/w.. P 0 Ifoa 2009. 9tocktm, <br /> w IuT <I cf:• ^a RECEIVED tY CA" nRMtl'NO. ✓'H�/.S.J <br /> / PEI A DUE AMOUNT REJA T CASH <br /> MFO <br /> {T� ^ I -�fe-4o 90-3►0 ,t . <br /> . MI1N INV.v�b VI .� .VV <br /> IX'�le <br /> y - <br /> A-i.'.L <br /> f b <br /> -'At "`"atwh�,A?z�3 <br />