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EFM bIE-`T 1W . AJC TEL :510-946-9968 Apr 2( ''=J5 13 :45 No .005 P .04 <br /> i <br /> 0 d rrb.JL <br /> APPLICATION � <br /> SAN JOAQUIN COUNTY PtMLIC HEALTX SERVICES ' <br /> ]MVIE6.111t EN`PAL dXAJ,= DI7ISIQN ! <br /> 4,45 N SAN JOAQUIN, PROVE (209)468-34$0 � <br /> F O' BC& 2000, STOCKTON, CA 95201 i <br /> 4 <br /> nAm ,,ssua l <br /> (Complgte it Triplicate:) I <br /> 4vtllCiot" is hrreby mods tc a" Jeiyuia County for & permit to ;vo*TrA t andicr '&atif.l: tho wrtslhertin e�scrib4a. TnaE; <br /> Nip11t4irlou 16 MAO ILPadds-azce Y1th dao Joaquin County 1662 wa 'tu Rulr&1"d R*v.LAtionw of Eon <br /> Joaq%AiX, Cqupty POWAC 11a4it1► aarYi�ce. i <br /> -lob Address I Wrtjrs , _ Cir Lot Size/Acute ----I <br /> ownw's Nang 3.517S Als.vm�33) YtY..a1's, .�� o.��r,� 2.5± ' - <br /> l..Ar1-BC10r V.ti0VlM4�M-:.�4ft,tl_rr._ Addiess .111. <br /> TYFbf op wetc-lump; h W WELL 0 WELL RePLACtMENT 77 MIA a7tl ovot <br /> —_ Pt,iAAP twsrALLATIprt SYSTEAI REPAIR 7. �pal. OTHER �eEllitAtrla(' Well 0 1 <br /> CV4TAt-CE TO fvEAPIEST: SEPTIC TAVK _ _ 99WEA LINES DlFPOSAI. FL� P. LkNJE <br /> s�..a 11rm c1..A Fs VNOAnON ACRiCuLTLRE WEi_k _ ort+LR WZLL __- _ Pi (qumrq ' <br /> 'N'KNUtD uSt T'PFE OF TFLL PR06LE1AAREA C_0_NSTRIJCTION %RK91CAT1OHS I <br /> X Induatrvi Ly OP,.dotwrr ;..j Marrlacs Dia. d Wrll L'xciw:ion i ;� `-- Vow 1 wea ceming <br /> [.: DotrtaniclPtivats D Grav44 Pack 5d T���sritld�.�+,S�Typo of Cas�+9_��... Li.m..._.;— 5prc rcai'Nm_._�)���,,,.,.. <br /> V! Pub4c Other fl DesTa rjpth of Grout 301 7.�..L.nkt� Type of Gran Vt c. <br /> I i lff�alvion P�^w.!041"K I I bateen Su-("*Sad[InstaWrd by + , <br /> Rpa.r W47a Ohne L- T n <br /> Of PurTI3 _ K.9, _---. _ . S�att Work Dood . <br /> YM Destruction �f ODivr,. r —1,, smiLm Material u pt n <br /> Depthto ik nuQ xr►tefsma 6 Dttpt1l ' <br /> TYPE Of SfOTIC WORK laflili 1I fl+r MkIN6 it oartk newer b <br /> .. AM 11 Not-1 <br /> ineoft on t•it"Fax NoW 1671 +pppea� <br /> n►w+tgr of tww+$grratA� r F4 �t�T- froo �,�,+ t ' <br /> Chanctar of mW To a aeo*of 3Go h ria AV fA <br /> MY TIG TA1DK L.1 Typtt 2ARM h1b <br /> wcG.TREATMENT FLT. �fa)�!�/d►-�Svsr Phoma g- L: a s w <br /> Duna Fe 2c-93 i/ .p I ; <br /> i-EACH1140 UNE c luo.3 Ioergpt at lines --- - -- — »� o:fl I.ngllw:,171a JY <br /> FILT$R 060 '.=: Diaance a)mtfarest: Wag�___ Fetyndutar7 ProPorw Ciro <br /> } <br /> $1/>RA8/PITS t , h <br /> $ins <br /> su u*S L' "mimes 4 noll t: Wal FaundRlirn_-- _-- <br /> M— �a4's�Y t.ir►a . <br /> DISP08AL FIDNDS a '. <br /> I hw4hy C4 &4t than t naw ptapNed this;appl}a&Ifer And that utle work,ra-be dens io itccaro3n�a Wish San_14aquin.noun v ordr7attcts,swr* ' aad <br /> rules and rsgdations of the San Joaquin Couo• <br /> HW-Q vwvww or ric*na*d ogwm's vignaTwe cvt,flee the following: -i CaratV Mal it thi vector, 1a�0 Dt I"wowlt for Whkh i:or*Dwmi in"uod.t&halt aw <br /> 4"WOV JAY DP40o in vitt►ortenrref as 10 600rno�INz'-b warkoW%t 3 cornponsat:co twee.;;f l: farr>;a" Co'un��sielor'%rririnP of wQ GPntrsclinQ signatura <br /> C*Ahi b*the fot;pwunp."I(*r'tltY that in thb owfar*sncrl of tt!e Vuck*for W%Vh 7hio;>rerrrdt•3 o r I thol•or-�p pa4*bh4 W 19911 to wortr'rnan'a Gvr*mpenu-� <br /> r <br /> tko tans of Cai4farnia l- � 1 <br /> The WWAM mu 1 f roan ie,&paetiaAa. COMInWO drawit9 rer side <br /> '+ShpMO X. s T+tla: * ' 'r• ✓� Oat : ._ <br /> rOtt OLFAKTUNNT tJ$6 ONLY <br /> r <br /> Applir.siian ac-•eP.od by l D«m: Arae <br /> Iia w Grout lmspe~by first inspection ar <br /> ` —i <br /> Adsi o-W Comments: <br /> App)i<"rnIIS - RLLrUrn Acd C4p1"b to: Sea Jar.gvin Crsuaty pabliC Kaalth SerVlaea y <br /> SOV1116amantal Nealth Pgrmf.t/80'ra1cv1' <br /> 449 A fan Josquln, p a flow 7400. BLkn. CA 95204 <br /> JgF4 A.AOLMl�tJR1E AMOUr *E&afTTSO `ASR RE vED SY DAT€ t'fRMR'rfp, <br /> 7- 1. t�+tr•Ea ME+,. s a� <br /> rrr u.rr <br />