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—1 7-1997 1 0.5 td FROM, <br /> • PLICATION FOR WEL. FUfdP PERR�yfZEL a <br /> I 1 <br /> SAN JCACUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION aX SIO 9-3, � <br /> -WA EAST WEBER AVENUE, STOCKTON, CA 95202 8c) <br /> (209) 468-3420 <br /> R0N-RUUMDA8(E PERVR FMRES 1 TEAR FROM DATE ISSUED <br /> M4aylet. b TrfpacstAl <br /> APDUC'ATION IS IrEFtE BY MAGE TO THE HAM JOAOUtN COV"Ty FOR A PEPIWT TO CONSTRUCT ANO.OA-STALL THE WOAIC DEBCRIS£D.71ue ADV\KATION IC MADE M CO MOUANCE`MTI/SAN <br /> JOAOVIlf COUNTY O('VE[APxENT TRIP.C74APTER 9-1 l lri_3 ANO THE t;TAr+OAMJg Of BAN JOAWW CQVHTY PVBt1C <br /> '�6 �f W-i LTN SERVIC£8-ENVIRONMENTAL HEALTH OMBtON-NPK 777'CZe_ <br /> JOB ADORESS:OR APt" `�- 3 ( <br /> ownEx�NAME lNJan <br /> mDF CITY ozFPiNAoPu, 7 AJz`WB5 — Q <br /> 33�Gvvwve� � u1(¢ 21,(,1.Ee tw,e( <br /> pq q <br /> CONTRACTOR C 5�. Zoo I IuCL�,{-�- .,S[x f-�70� Pt+o •Jv0,0 /�- /DZS <br /> C AootEss Ucs <br /> IA,.CDNTRACfoR r.l�i f tr - s;56 R�wJ• C 5 7 <br /> y (925 i 3— <br /> uc, v++of1E`"J 3 <br /> TYPE OF WELL,JMP• ❑ NEw WELL ❑ POtACO ENT WEAL ❑ Mo"TOArNa WELL/ ❑ OT"" <br /> D fNBTKU\TION O WELL RySTEM PMPAIR ❑ CA082CoN04ECT AEPA41 ❑ VAPOR EXTRACT1oN WELL p <br /> ❑N-❑R.P.S. H.O. DEVTTI Pv.n ter cT_ J <br /> (TYPE OF PEIMP) Fmgr WATER LrvTL O <br /> ❑ OVTOF6EAVtcE wEI.L ❑ 0EOg1YSICAL WELL r ❑ W4 DOrCNO <br /> / 8 <br /> OE BTRVCTTp N; �\ C <br /> INTENDED UBE YYVE OF WvLLCONYll ECIfaCATfON'&l <br /> —' BOTTOM OrA. VJM UCAVAT1oN <br /> El rNousTR1AL ❑OPEN .r <br /> ❑ DOMEBT1CJPMVATE ❑OAAWL PACCMZr: - DIA.OF CONOVCTOR CASeNO D <br /> ❑ waLlcn vFBCrPAL ❑oewEN TYPE of cwsA+OierEEIJwC MA.OF WELL CA=NO .4 O <br /> DEPiN OF aRovr CEAL SZ J .�J� >�CfiKATpN <br /> ❑ rR(21GATION/A0 ❑OTHEA OROVT CEAL 1NWrAU.FV$Y T Fp IM `, Y OROUT EPRANO NAME R <br /> Cl MOMROAwQ OROVT SEAL f VMPED: ❑Y— ❑Nr. CONCRETE PEDESTAL SY OIVU.ER•❑Yr ❑Ne E <br /> APF"Ox.ourym 815 LOCKING cHEcrrA SOLBTOVE PCK V <br /> PAOPO em CONBTIIUCTION/DPHJJXG MErH00; MVO ROTARY •s <br /> AIR AOTAM AVCdR GA6I.E OTHER <br /> I HEaE9Y CExTIFY THAT 1 IIAVE Pvgf^ F,D TW S AP"-CATION ANO TNAT THE WOf+t wILL S4 ootq M ACCOf 3AN"WITH BAN JOAOUW COV <br /> OICWANCY S,STATE LAWS,AND RUtEO ANO <br /> T�cVLATIONB OF THE BAN JOAOUM COUNTY. Now QWNEA Ort LICFNOEO AGENT'S f11ONATVrt CLCTMfis TNTI POLLOWAW:'1 C[TfTI/Y TNAT IH THE fLNANCWI,FIC(Of TTtE VV\1AC POR WNICN <br /> TMB P£RMR IB f88tT'ED,(111ACL T 1A3AMOY PERSONS Ski"CY TO WOrOOM.Mr1 co%wetS An"tAW4 Cf CALIfOfv+Tll.' CONTRACTQR'S HMTFIO OR BVB-CO}n'�ACTtNO wONATUrt>E CCR7MGV <br /> THE F-OLLQwINO: 1 CERTIFY AT M7 TIE"-RFOWAANCE OF THE W"W FOR WHICH TMS POW"IS 18BVM.I SHALL ZMKoY PERWHS stMACT TO MR <br /> CALfOrv++.l' APTCK SB$40UPA tN AZ2V^M"POR ALL 1ffiMLm 0 ARF AN'S MCD. sATwM tAws O, <br /> 11w/4CT0�/SAT C/sbel 4ss�tt. OAA�NNO AT lnwEA AREA 1/TOVTOEO. Q <br /> BlarrdX / /'I•!/CKt[� 1V �Z''�TIW C���CSOId!/n'4� J�it.6�'5��.�� ! � /\� <br /> 0w• <br /> ►LOT FLAN 10—Y S6.94 StW •M -..� <br /> T. OtTTU OF QTHE Pn OR ROADS NEAREST TO N A_t.V Opr TF1!PSt""O TY_ A. LOCATION OF NOV"SEWAGE Ot®OiAL SYSTEM on I'AOr,*GW <br /> Z OtTTtINE OF THE PROPER>i Y.@VMq OAIENSIONS AMO N011T11 D1nECTTON. <br /> 3. DNAO#f,ONED OVTUNF.S ASA t.00ATION Oi ALL EAWnftO AND P4000/W Ek1JW/10H OC"WA09 D1G OSAL SYSTFJAS, <br /> STMICTM-a�o.*jCLVVM LQy[IDArIFA>s i. LOCATION OF W UX W1TMN RAMS OF OMX"VNCMM vWrY FT, <br /> rf"AA PATIM OW4WAYO,AMO WA XL ON THE PADO'E'ft1Y OR ADJ004144 Pmpg RTY. <br /> lot <br /> ...? o..4...... Pik ` ........ <br /> j rt 55 <br /> nru <br /> ( ) was, <br /> . _._..�.........q. <br /> .. ... <br /> ................ <br /> t <br /> .. •1. ..•, .w ni <br /> ........ _ .•.J.. ...... .. .. .... <br /> OOA11TM6'fT VIE ONLT <br /> Aw—A—Sly.. '�J -f/fiA� !/ � � o-- � Cl� <br /> aw Yw�e6+tti Os" P1sAr, r.w 6y. <br /> - <br /> D�ee <br /> ACCOONTING ONLY. AIDS _ PACO <br /> BE coo" PIX PNO AAIOIMT m"TTtap R$`9VCo BY OAT! Pepl*Tpe-="GUEST NUMSOR Il1NOICE <br /> 3S0 r o// z !//6/y O/7s(o G <br /> y� <br /> t . <br /> o <br />