Laserfiche WebLink
APPLICATION FOR PERMIT ! <br /> r <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES I <br /> ENVIRONMENTAL HEALTH DIVISION � <br /> P 0 BOX 2009, STOCK T011a CA 98201 <br /> (209) 488-8447 <br /> BRRMIT RIPIRES 1 YEAR 1PRnM DATR IEi9 RD <br /> (Complete in Triplicate) <br /> Ayplicsttea la bt"W RM.,te esa Joagsi■ 0011111? for a Peron to comtruat and/or install the wort herein described. This <br /> appuestlaa is rids is "ovum" with I"Jeanie camty ordinsaea eo. S49 end 1862 sad the Rules and Negultitions of "a <br /> feat"s Canty Pubus eealtb Servloes. <br /> job Address 2173 West Yosemite c;NManteca Loteise/Aeresee -6 acre <br /> Pleasanton. CA 94588 <br /> Owntsr'a Nanta AT & T AAdrest4430 Rosewood Drive p,,415 224 1547 <br /> Can„miMClark Well, Inc Adoratf2024 E. Chat-ter License No.371560 "0"462-7676 <br /> LL/ M . NEW WEL00 X WELL REPLACEMENT 0 DESTRUCTION O Out of 8artrlea Wall <br /> PUMP INSTALLATIONKI 9 x SYSTEM REPAIR L, OTHER O woultoring Yell a <br /> OISTANCE TO NEAREST: SEPTIC TANK SEwFrt LINES DISPOSAL FLO. PROP.LINE , <br /> FOUNDATION !AGRICULTURE WELL OTHER WELL PRS/SUMPS WWI <br /> INTENDED USE TYPE Of WELL PROBLEM AREA CONSTRUCTION SPECIFICAT!2NS l <br /> x!1> ami e O Open Sarom UKMWO a Die.of wM Eaawtion Die.o1 VWII Gas”" <br /> L1Ooff4wieiP►MM 1f T. Great Pack OTracy TypeofCaw+g Srpp1 - ----- Specrftstions -'175 ('RF <br /> D PubMt '1 O DOM Depth o1 Grout SOW 10 0 r Typpe of GrQ as r k <br /> 0 brrpatipn �I ...Depth 06-18 Surfaco Seal tnstaaad by C l a r k <br /> Nook*worn Done O Toast►trap Turbine H.►. 150 Stats Work Done i n a r A 1 1 <br /> G Wee DatnreWA O IMM DlatatM esaliue IlaLarial a Depth ! <br /> t Doh 1•111sr Irterlal a Depth <br /> TYPk Of SEPTIZ WO K: NEW INSTALLATION0 REPAMiA001T10N O DESTRUCTION D (No none sy.W"parmwMd d prbke awn is V� <br /> avatiabls within 200 Het.) <br /> R m1ftNon VA ani. Reaids We— Coo whent _. Other <br /> fMurftbte oI Evina unite: NurriMr of bedroome <br /> Clwbetw of son b a depth of 8 Het: Wear table deigns 1 <br /> W11C TANK O TWo/Mfg Capaltr No.Ce Werwf nws <br /> PKO.TREATMENT PLT.O Method of Di posh <br /> Okunea to nears": Wens foundation Property Line <br /> f <br /> LEACHING LINE 0 No.B Length of Brae Total"th/eke <br /> s FILTER BEO O Distance to nearest: vias Foundation - Property Line <br /> SEEPAGE PITS 1 I Depth Sin Nurnbsr <br /> SUMPS LI DiNrros a nostear Wse foundation Property Lina <br /> DISPOSAL PONDS O - I <br /> 1 herebythaeaRitY t 1 have pMed this apokt:afien and that da work vtnn be done in accordance with Son Jopuin county ordinances.state laws.and <br /> rules Md regulations of the Sen Joaquin Cewty <br /> —=Monte owfq►a keened agent's sgnsw►a oarttfin the following."I crMy that M the psAwrnanw ce of the wort for wtuch this psrrm" issued.I span not <br /> _,any PMtlott N such rMrwter ate bacon na subject Ip workman's oorhOOMaon law•of CaManio.'•Contractoes he"or wb-contracting signature � <br /> We the Ieaovv!a :"I earwy #4 of the worn for Much this prnrt Is esuad.I Nap srapfo.PefaeM subraet to workman's coraosnn- <br /> tion taws of CaMfaNe.- <br /> The appkeait a Complsu drawing an rsys►ss ads <br /> Well. Inc Apr i lgtsign" TW .VP Clark <br /> DIPAR <br /> AppkCatiort Accepted by 011 4-A-1 r Arse y <br /> PN 0rou hteo.etion W Ds flMl Date <br /> /,adltlenal caInF"remvw:1104111�% �Ituro 611 Mies to:9` <br /> IN �I � <br /> a1NXTAL � iioPIMMITiavtcse <br /> SAN i Bwsoaragaeol <br /> IEE AMOUNT DVI AMOVNT FI MMD A M RECINEO By OATe PERMIT NO. <br /> INFO <br /> 1 <br /> �j!- O j <br />