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11—OS-1997 1:SSPt,l FROM <br />P. 2 <br />APPLICATION FOR WEWPUMP PERMCI' <br />SAN JOAQUIN COUNTY PUSL1C HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DMStON <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 469-3420 <br />WOW-REFUXUA8LE PERMIT EXPIRES t YEAR FROM 13ATE ISSUED <br />Mam loot In Tr(p5cmj <br />APPLICATION IS HERE BY UADE TO THE SAN JOAOUP! COVWY Ft3R A PGMWT TO CONSTRUCT AMDIOFt WSTALL THE WOM OESC-MO. T -M APPtJCATION Is %&A -DE M COALPUANCE MIRI R SAN <br />JOAOUW COUNTY DeALOVIA04T TTTtE, CHAVTUR 8-1115.3 AND THE $TAMOARO{ OF SAM JOAOUM COUNTY PU9M HEALTH OC R IC M EMAR000JENTAL HEALTH Or Al H. <br />JOB ADOREesvR ADN+ (-,r-- � TI'c.r7s r , ( l4 ,14' '. i� � v/rY (— vc.1 PARCEL SQfJAPNr <br />otNNfR'{ NAME ADOFtEIi P►xJfIE r <br />COHTAACTOR_�IIr �/�I�U �✓�-Y�/r <�'t^1/ I �✓1Lcr �, i .� % ADW�E9{7�7 �% f -t -.ice`; li il�IN/ir. m, PN--m/F?�� .G-7.. <br />SOS CONTRAt:TOR l.(�7 `7 l �:�, � w;r 1/.' l . AOORiti =;i i v �-f 7 I p� Qr/ LIC r_G� Ng79 R4NE r i (�-6 77; -'7 / <br />- t <br />TYPeofw- L UAIP; ❑ HEW WELL ❑ REPLACErAENT WELL Q F.-ONTTORtHG wal l ❑ OTHER <br />❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CHOSSd7o1a CT REPAIR ❑ VAPOR EXTRACTIOH WIIL + J <br />❑ H... ❑ rkydr H.O. DEPTH PLrw STET FT- FIRST WATER LEVEL O <br />(TYPE OF PUMP) [IOUTOF-sER'vICE WELL ❑ GEOC+nQCAI WELL + ❑ OOTL �� s . <br />❑ oESTRVcT)oM <br />AIOr FACS <br />WIENOED Uti <br />Tyr* Of WELL <br />CONATw TMDM APECiiCATIOMA <br />AFAOLMT RENRTTED CFACX11CAlH <br />10-0 3 z r- <br />❑ *,OU TP3At <br />❑ OPEN BOTTOFA <br />VIA. Of wEL.L EXCAVATION I <br />DLA. OF CONOUCTOR CASINO <br />❑ OOUFSTWJP''MVATE <br />[IRAPACK/WZE <br />I, <br />OF CAftIN016TEEl1PVC f'(JyC-- <br />TYPE OF <br />OIA- OF Wnt CA -17140 __ L 1 ✓� <br />Cl PUBUCASUNRCTPAL <br />❑ omv%N <br />OEM 14 Of GROUT SEAL I -7 �� % '" 1 <br />_ SPECIF1CATRO0d <br />❑ IPILGATIOWA,3 <br />❑ OTNER <br />GROUT SEAL *RST ALLED BY <br />GROUT BRAND NASAE <br />® NpNTTOMHO <br />GROUT SEAL PUMIPEO! ❑ Y— ❑ Nr <br />CONCRETE PEVESTAI SY D -ULE C ❑ Y— ❑ Rb <br />APPROX. OVTH q /�/ LOOKING CMEsTER SOX/STOVE PIPE <br />Pao POtm CO NOTRvciTOM/DRWRa 16117 6400. "UO FOTARY A[A RIOTARLY�i7�',' / �..�tIGER <br />OTHER, <br />I HE'Fe't' CERTIFY THAT I NAVE PREPARED TMS APPUCATIOM AND THAT THE WORK WILL 6E DONE M ACCORDANCE WITH 84N JOAOUrN COUNTY OR0IPJANCE9. STATE LAWS. ANO RULES A.0 <br />r*GU ATIONS OF TWE SAN JOAOVM COVM'TY. HOME OWNER OR UCEW"D AGENT'S SICMATURE CERTIFIES THE FOLLOVANO: 'I CERTIFY THAT IN TME PM ORAAAMCE OF THE WORK FOR "ICH <br />THIS PERARRT IS 189ma. I SMALL HOT EIISMOY PERDON'S SVRJECT TO WORtMAN'S CSI►APENAATIOPI LAWS OF CALIFOP"A.- CONTRACTOR-{ Mit NO OR 9KIIs•CONTTtACT0+3 SZGW ATVRE CERTIFIES <br />THE Pot -LOWING: ' I CERTIFY THAT M+TI/E PEFIPOI AHCE OF TME µPORK Fon %/^oCN TIRE PERMIT IS McVW, I SHALL EMPLOY PERSONS VL JECT TO WORIDAJIRT{ CO"I'"AATIOM tAWF OF <br />CALOOMIA^T61C APPUCCA//ETT MU7t CALL 24 HOt MA M ADVANCS OWl AU MQURED rXzrvcTORd AT ao" 44twylg. COURuTE OMMrtNG AT LOWER AREA PROVROEO. <br />PILOT PILAX RD•«I le Seat/ Sew ' to <br />t, NAUE6 Of eTMFTS OR POAOS NEATEST TO OR OOVHDRNG 714E PROIT'RTY. A. LOCATION CO H' EWA E DI&POWAGF AL SyTrEPOSAL QTST'ET•a OR oROIV 6E0 <br />2. OUTLINE Of THE PAOPERTY. GIVING Om"S"O" AMO NORTM OIRECTION. OCeAAR910H Of SEWAGE pl{FOSAL {YsraAs. <br />7. DI{/ENSIONED OVrUWS ANO LOCATION Of ALL CXIGT7E47 AMD PPOPOSED 6. LOCATX M OF `^n" WTTHN,t,LMUV OP ONE HVNO>•IEII f6'TY FT. <br />VpVCTURES. V CLUOINO COVEWD AREA9 SUCH AS PATIOS. DRTVt1'VAYS, AND WALXS. ON THE PPOPERTY OR ADJOPRHO PROPERM <br />......: ... ....._... _-:.. _.. ...... _ <br />.. .. .. <br />..... ..... . <br />OfPARTIaE71T USE VNLT <br />O.I• /+..�" P <br />APPa,,,.,.,., An.ee..a e♦ <br />IIKA <br />O—A By pr.I• Ptsro 4aPa0an BY <br />D.h <br />AcceulrTlNo oMtr; <br />AIOr FACS <br />FEE Y<PO <br />- <br />AFAOLMT RENRTTED CFACX11CAlH <br />10-0 3 z r- <br />RECE2VEO {r <br />N -k <br />OATi <br />Z co <br />/'BtMfT/{ERVICE REGMT KU GR <br />S►Q-a o i v 7 �Z <br />wr oeei <br />f'S CODES <br />pUp. Heatth Serv. - EmhD. 173 (1197) <br />