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r <br /> �&QUIN <br /> APPLICATION <br /> SAN COUNTY PUBLIC HEALTH VICBB <br /> XKVIEMALTH DIVISION <br /> 445 N SAN JOAQUIN, PSENi'$ (209)468-3420 <br /> P 0 BON 2009, ETON, CA 95201 <br /> (Complete in Triplicate) <br /> A ilttitslca io ustoldr . to'S 4040115 • f'rar a perch to oorAUwt 601/orinatlal3 the waft hroIn described. Tbia <br /> apyiiontlaa it awe far Cer 2 ipca-cruet Baa Joaquin Co=ty Ordiseaoe 1o. 549 and 199 cad tba ibrles sae fbpulations of Sara <br /> Joagttln t Public Sp.ltar aervioes. <br /> .FobAde#ma _454A Wfiterinn Rnad City &tackt•on Lot Slae7Acr6e nZA <br /> o mw*Naar Jonathon Marlowe Addy m P,O._ Aox I S Q-2},,,1 phone4 5 7:- <br /> San Rafael, CA 9591c� <br /> Cantractor est H$caL t Address 184 3 M. March Lax kense I.�y�,.... 2 E <br /> OF W W.l WAP: MW WILL WILL REPLA*M NT C1 DISTRUCTrON 0 Out or 8errlcs F34 <br /> PUMP INSTALLJITM C SYSTEM REPNA ❑ OTHEA 0 Ilooltoaiat esu <br /> OISTANCE TO NEAREST: SEPTIC TAMC. -..- SeWM LINES " *_.....da OISP05AL FLO. n �a. PROP.-INE 1 r <br /> f:ONNOATIQ*.- .r. . AGRlCULTURE WELT OT WELL 1 S(L MTV SUMPS <br /> tN3M use TYPff OF'WEW PROBLEM AREA COtJ lUCTION SPEORCA1T10619 <br /> El Industrw 0 Open,Sotwa 0 Manteca iiia. of VM Excavations Dia. of WN Cmft " <br /> CI Otwwiw rwaw v tiwt�el ... . O Tracy Type Of.Cssinp P C SpeoCaisna <br /> I'I Public n ww n Dake DaWh of grout S 1 �, 9 0 t Tv"of am!Ne n i-f"lp_and n <br /> A90". Oquh H l sewn Surface Serf Inv wiled bys` 1 yrs h" 1rey W1 SOME <br /> fwpair Work Oone a Type of Pw+Rr <br /> WW <br /> a wo oiggtt.w —2"---�. ifealsaa flat�tri l lti Wpelt <br /> Ora. . 2}. 7131w Knurl" 6 bl"h <br /> TY : NeW iNSTALLATM I I WAWAO0ITION I I BUTAMTON1 I INo naptic syaten,pw nit d if public sewer is <br /> available within 200 tea.) <br /> tnuft0 i rwlitiswe: tlsaidence..:.. CaftnartM 00w. <br /> M4601 of NW4"Mw *w6w.of bedroon+rl. <br /> Character M soil m a depth of 3 falai Water table depth <br /> SEPTIC TALC. a T**7Ml2 Gpebllq Mo.co"per"wo <br /> PK(L T%ATMIMT PLT.a M014 ad of Oitpatel <br /> Distance to nearest: WeN__�_.� Foundation Prrrperry Line <br /> 1" G No,*L 0.11F+OeTotat Mn1w <br /> FILA al v 0 Ow"n"to nasteM well Foundation Property Lute <br /> j SISPAM PITS l I Depth OR Hwt>ber <br /> SUMP>< iri Obl we so nd.SH : VM Foundation ProWty Line <br /> . t'�SAL:I�IQS <br /> 1 Alreby. .a+et 1 have preltewrd ihM.applcstion.altd thn dna wont wEl to'do <br /> inacaordirtp with sen Joaquin wwnl►ordirtsrrcq;arae Farre,';and <br /> aViso a*aapiiabne of the San Josqui n Cato 7! <br /> Anne,ownw.0 I1wM+0-00'C><.ftettPo im oft rIM 104"I tw "I,otNdly the lel. of the week for which chic pem*is issued..I.sbM nttt <br /> me""a"pow in Swh rttinrttr as ro Oaceth0"bjecr to wort wwva ooffowwirapt bars ltf CoWoffM."Corwma s hkiiq or cub-cortRracdnp sipnrrwo <br /> 7. "1q'% iatthwwo**►wlgoh this psm*is.Issuat 1 titsM employ persone sublsct ra wodkmeds eoswow w <br /> don errs of Caflii�rnie." <br /> Tlttr~appfearar1 4.1. CettnpNte dwwkq on rwrne side. <br /> Siprree yw. alow-l�r�►1 391low <br /> — Dow. <br /> OVA111TMUff USE ONLY <br /> .Ason-wO Date Z -�lZ�.. Area. V <br /> Plt or saw 4wo.den w 0010 U_z2L Fkt.I ir�.peadon.by Oars <br /> ,►dtlltioa.,rorttmen IsOtl V [3- W <br /> Applicant - Aetura all copies to: :aas doing"". County Public Sealth cervices <br /> > awaltb tlas:it/Servioea <br /> 444 N Sea J01041 lo. P O:ftx 2000, Stka, OA 96201 <br /> /1MIQlIfIT ONE Ate'IIAI?'!'ED A N RIICSVED atV DATE <br /> ItMT'MD. <br /> . wM <br /> to»war.uv.�.. a _. . .. �ry )K19! 4 S •Z ..c{Z 2-ZC <br /> ilir sat- . . <br />