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APPLICATION FOR PERA11T <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)488-3420 <br /> P O HOZ 2009, STOCITON, CA 95201 <br /> PEBYIT EZPIRHS 1 YRAB FROM DATE 12SUED <br /> (Complete in Triplicate) <br /> Application is berelp made to 'fan Joaquin County for a ptrsit to construct ard/or install the work bereln described. This <br /> appliostion ie r W is eespliaws, with Sea Joaquin County Ordir.ace No. 549 and 18" sad the Rules and Ilegu"Llona of ban <br /> Joaquin Coueq Public dealt►for. a". <br /> job AdOrasa ? ��!s e�� HCik �/���_ yy!►Lot Site/Aereap <br /> Own"'f Nen.-5A eL�L41 Address 4:rrrl yMlY7i7irs�i.d /• ►hor. <br />'i Contractor Addrrff kenft Nov 'Tr�, 0Q done <br /> 1 Y t Ir <br /> WELL NEW WELL O WELL REPLACEMENT OERTRUCTION Ll Out o se 11 <br />' PUMP WST4LATION O SYSTEM REPAIR It OTMER O Monitoring itch O <br /> 04TANCE TO MARE SEPTIC TANK SEWER LINER DISPOSAL FLO. PROP. LINE <br /> POUNOAT*N AGRICULTURE WILL OTMFR WELL PITS/SUMPS <br /> NfTIMM LIE TYPE OF WILL PIMLEM AREA CONSTRUCTION SP£CMICATIONS <br /> 0 wuww O Ow Paean O Montsoa Dw of WWI Etcavetior� Ow.of Wef CaYq <br /> 1 Id Ootttsstlollhwoa O Grwd Psok O Tracy Type of Cairq--- SPKAC&tim" <br /> I1 Pvw CO odw f l Oohs DNM of Grew Sal _ Type of tiat. <br /> ._Approa.080th�""//1 1 Essf"rt Su" M. aed tsIvy <br /> ReOOM Weak Os 4k TTwo of PunttO„drY.r�_ H.►. / I ... <br /> W1011Dowtoed" O WIN OMMvmM Haling wtreri l & Depta <br /> alp* Pillar wtari.l d Dkptk - <br /> f Tv ? p $ 1 : NEW INSTALLATION I 1 REPAM/A001 ION I I O TRU 1 "Pfic Ham p"rot od t public saw"is t <br /> ovoitsOIo taANWI 700 tat l <br /> ir88aEWIMt trim ttatrft 91i wa IN craaadt w— Od.r PAYMENT <br /> Pb w&w er flvYtQ wjw lfrrttbw of w*4w. RECEIVEDwaNr a01a diol <br /> t7tfasm M sad M a dopik of i wr: -- <br /> >11MIl ti TANK. O TYWM% <br /> M&TMATWNT OtT.G SAN JOAQUIN COUN of�a'M <br /> OkWW b ttrrot: WW1 Pear .ON L14 i T t� ? <br /> Iti N !{OIyi61AN <br /> LEACRVOG Ufa Li No.!Lonom tv ow Teat len WWW <br /> FILTER 00 C Oirpatso a"mo*. tAh1 PoaAssIon_..._— PttvOMW tiro <br /> SEEQAAE MTS 1 f Depth Stye <br /> SIJM►4. LI Ellataf.o to maOM Wal PorwrdntbA — PvoO"N Lkw <br /> D11MM PONDS <br /> !hm"W"t.t I ltovo PreOMod*48 pad ala the*wt w0 be dome 1n secordma wth San Joogwn county o"Www .w.sea Iowa.and <br /> A"tlRd fgtrlBNorts N I"Sow jeowt t 0~4 . <br /> He"ta,Mrs/o►EOMtId ands WrMMA a WW"fin so4owing:'1 cortRy ow in the Porhum anon of tM work for vr/tkh this Porro*Is Issued.1 d.a not <br /> MwlfRy May/bran in twoh IIwvw 14 M MpRtb•rfhwt a woortw*s osmpW4~Iowa M Cabfarna."Contractor's hk"or we•contrUlft I*MR rye <br /> ow" ke On htUwow 11 oarfp ow to"OMSoMawasa of tato wm%for at "Mrmk is boto4 1 enol anyMy Pa w subfM a w"kmon's aetnpaW- <br /> an Yaro of C101100111." <br /> =112("-= <br /> 411110111W frefrs Cew�PIoa drawMtg o�n rQw,ora�o aidk <br /> �.�� OR PVt1HNW— p. <br /> APPg..tlen AaekOfs/w ....��d � 111P ,�a,a �r / <br /> i f- Dilltrs�j <br /> Ph efoe Slykwt fltyMulM w It" <br /> h.petlk�t <br /> AdOMWW : <br /> &pplioaat - Return all copies tot fa■ Joaquin County Public bealtk Services <br /> Raviroaaeetal Reaitb Parttit/Servicer <br /> 116 If P O Ron 20W, Slsa. CA 96SU1 <br /> F" <br /> rMN49.SIR AMOUNT Ot/l! AMOUNT RfM("10 11/CIPAD gY 0 TI PIPAMT <br /> t+rrale.t,ear , / ` MO. 4 <br /> 3' �:V <br /> f544 .4di. <br />