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. .Nary...+w...n:.r-+,...-...c•..�••,w+.».. �..�++rv.r..yv...,...-... ..........._. � ......�......�-...w�yf� <br /> APRLICATION <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIROMUWAL HEALTH DIVISION <br /> 443 N SAN JOAQUIN, PHONE (909)488-3420 <br /> P 0 BOX 2009, STOCKTON, CA 95201 <br /> PasfrTT HZP1[gSS 1L n" EM DATE ISSUED <br /> (Complete in Triplicate) <br /> Jlgplscatsea <br /> is !aunty �.ti� rs�sA�he J rse CaeRt ia�itte o Shy "A IOU a0 thi Rthe ul�e. .MeeNIM{ul+ti et Me• <br /> smueatsoe so tttsda u coil <br /> Jstyasa f suey M►lse sealth Sat+se". <br /> Cat/��ft!!'aaactttwi.+- Lot Biu/Acrease 3 <br /> Job Address �-41 L�M � <br /> i. <br /> x <br /> Owner's Nemo dtkw <br /> I AdMess License No�fl/ _ <br /> ContractaR ! <br /> PE OF WELL NEW WELL O WELL REPLACEMENT h DESTRUCTION O Out of Monitoring <br /> all O <br /> ' OTHER d'1.. Mc°storinS thll , <br /> PUMP INSTALLATION A SYSTEM REPAIR O <br /> PROP. LINE <br /> DISTANCE TO NEAREST: PTIC SETANK ,_.._.—_ <br /> SEWER LINES __ DISPOSAL FLO. <br /> FOUNDATION AGRICULTURE WELL OTHER WELL FITS/SUMPS �. <br /> INTENDED use TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS OI well Cawq <br /> C7 rrd oww O Open Bohan O Manteca Die.of Wes Excavation t <br /> 1�DonwtielPrivsN O Grovel Pack O Tracy Two of Caging_ S0 <br /> 1'1 Pubk <br /> Cl Ottrt Il Delta DWh of Grout Seal Typo elf Ortwt <br /> I t O+gNbn .�ApPror• Deoth�/I�II�Eastern ' nrt Sea nata9ed by <br /> %W*Wok Dane N. Typo of Pwnp.AUJ,- _ M.P. State�ort�+Aol <br /> w 1 <br /> !feeling Material a Depth <br /> Wtw osuction O Co piernetar !shay hlstersal• Depth <br /> oaolll <br /> TYPE OF SEPTIC WORK: NEW INSTALLATION 1 I REPAIRIADDITION 1 1 DESTRUCTION 1 I INOWPI C Systithim lerat.�I pbk stowstows/be <br /> avale (j t <br /> byasbtior wo anus: pow-1- ._. C.orrrnarClal— Other W <br /> Number of Yvkty unita Nurnbo of bedreor f <br /> Of 3 Net: <br /> Charenw of of to a depthWater table depth <br /> c.o.ntr IP#,*MP�"tlBf <br /> SWM'TANK O TypalMsg �f YC V <br /> pKa,TREATMENT PLT.O <br /> Olwena to Via~: WON Fandetl is.�_-- F ` <br /> t i <br /> LEACHING LINE 0 No.•Lanpth of linea To1N t T,11 SLRVI ES <br /> FILTER BID C] Obtanee to rtanaat: Was Foatdal�rl—EN'�IR�O_ All N'�AHEA lH DIVISION \" <br /> SEEPAGE PITS 1 1 DW% —S44 Number <br /> LI DiRance a rte fW. WooFountle ion Property Line <br /> SUMPSa <br /> DISPOSAL PONDS O <br /> WW Mel W4 wok wit be Oar in accord&—with San JoapuMl County adirMnCas.Nete avva and t <br /> 1 InerabY prtHY that 1 have papar'b this appkcatgn , <br /> woe and ree"tiens at IM San Jpequin Comint7 1 t M1tfI that M the paAornw+ea of the work la whkh flus pnmt i•issteed.1 Moa not <br /> Hoer owner or kCartead agerN a algrrtwa eartiflaa eM losowtng." avve elf Celilania."Contractors hiring a Vjb-cemrectkq�pnak" <br /> errplotr VW so In such nnrwtn as to 110600111 ttubfeet a wo►man's comparrNbn <br /> Carl"to fosoAtrtY:'7 Ctlft Ire in tM preform 4*of 1M Work la whneh the PW N iaMNe.I alnall elAnplat pMasM wtgaet to workrnen'e COO 0000 <br /> tion awn of California." <br /> Ter appaeam <br /> r"uil Inspections Compote drawingras da. <br /> TxM. Dan <br /> ign -- <br /> Sed <br /> FOR l/ <br /> Date fee <br /> Appkaw Aecelot by <br /> Pit at Orout 4sat:tbn by <br /> Dao — Final Impaction pacn by Dar <br /> AeldltlatN Coettrttante. <br /> Applicant - Return all coDiwa to: San Joaquin Couetr Public Health Services <br /> Cnvtrontental Health Permit/Servlcee <br /> NN5 R San Joaquin, P O Boa 9009, Stkn, CA 95901 <br /> ^vi'i <br /> AMOUNT nIMITTIO A N IIICINW aY ATI �IrlMll rn0 <br /> yC1 INFO <br /> . tM <br /> 13 34 lento ,, <br /> IN 11 as <br />