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' APPLICATION FOR WELLIPUMP PERMIT, �[ <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES' <br /> j ENVIRONMENTAL HEALTH DIVISION iR <br /> P 0 BOX 388,446 N.SAN JOAflUIN ST,STOCKTON,,CA 96201.388 <br /> ' (209)469.3420 I' <br /> € NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM GATE ISSUER <br /> ICGTBPirh 61 TrpOwtil 1J <br /> APPLICATION M HERE BY MADE 70 THE BAN JOAOVIN COUNTY FOR A PERMIT TO foNSFRIICT A1LO/Op INSTALL THE NgJa(OEBCPoBEO.TNIB APPLICATION t8 MAGE pf COMq.1AMCE yyRN BAN - <br /> JOAOUsI'GOUNTY DEVELOPMENT TTYLE CHAFFER 9-1115.3 AND THE SrANDAme OF SAN JOAOUII COUNTY FUSUC HEALTH SERVICES,EIMRONMENTALa MADEALTH OR Co <br /> JOB ADOREsBIOR AH,r !6 D' Sn 8 Crn S rJC ID,.S C'f) <br /> rQ nwNEn•s ' PAN .4 .' ADDRESS aJEqE/AFRI ._ <br /> q.g .,�� 3 <br /> FRGNE. <br /> ']aaI S., A.'sc A4,0 <br /> cnNYRActoa_._. V Ed4C V En�� ,(a/ n to ADDRESS , 1 <br /> { A - PRONE F�/�.•�SZ�I!$ <br /> SUBQONrnAcroa V 1•Al AA)z.LL,fJ 6 AppfESB P.p Ocx S/ "Ric d+srA LICr_}IOL)D^_PHONE#11-114.2,91i's <br /> il-A <br /> TYPE OF WELLIPUMF: ❑NEWWEIL ❑FW%ACEMEM WELL MONITOPoNOWELLF N❑y1'OTHER <br /> ❑INSTALLATION C)WELL SYSTEM REPAIR ❑CRoss.CONNECT REPAIR L Ac}1}lca) IghyAPOR EXTRACTION VIE"r 4/JL/•2 J <br /> ❑N.n❑RwNlr N.P. DEPTH AIMP BET FT. FIRST WATER Lava ` O <br /> RYIrt Or PUMPI �� f <br /> ❑OUTaF•BERVICE WELL ❑aEOPIf =AL WELL r I ❑ 80rL somw B <br /> ❑DEsraf&-WOO: Ne R Es L' " AJl W-I • ''ZisfoLlf w s (Vm-i LIAI.2 <br /> .F <br /> INTENOEb USE TYPE Or will CONSTRUCTION SPECSICATIONr II <br /> ❑RRIVgrim ❑OPER BOTTOM OM OF WELL EXCAVATION_ n/0--7.4 DIA.OF CONOUCTORCASsNo D <br /> ❑DOMEBMPRIVATE ❑GRAVEL PACIUSUE TYPE OF CASHOISTEEtIPVC /' G t A <br /> . ONAI.OF WEu cAefna � MUI Al/l z�D <br /> ❑weuciluvNrc>pAL ❑I�FPI Dm EN DEM OF CAOUT REAL SS`IA�wH��-10'l 04j)-PFc cATaN b AJC. R <br /> ❑WMOATIONTAG HIOTHERII(Ijl'R.r MSI:f MLI aaour ff-L INSTALLED BY t?. Gaour e1wrD NAME A <br /> J OLtLQwcY__&,.t E <br /> LGNITORNO �MW.NI� GROUT BEAL PI MPP MYw ❑N. 1€ GOI7CRETE PEDESTAL BY DRILLER:❑Y- ❑No s <br /> ArPROK.-F-- F1, UKXM CNEBgR IQ 19Tso-TVERPT.�IPE 2JIL4 EQ a <br /> PROPOSED) <br /> ROPOSED CONsTRUOTGNMORLNO METHOD:/ADO ROTARY AIR ROTARY AuaER1 l -i cAs1.E '` aTHEIl - <br /> t HEREBY CERTIFY THAT 1 HAVE PTEP 0 THIS APPLICATION AND THAT THE WORK Wm BE DONE IN ACCORDANCE WITH SAN JOA <br /> QUIN C0ITHTY•ORDINANCES.sTATE LAWS,AND RULES AND <br /> REGULATIONS OF THE BAR JOAOIAN L'ODNTy.HOME OWNEq OR LICENSED AGENT'S IiGNAT1IRE CERTIPIEB THE FOLLOYANO:•1 CERTIFY THAT IN THE PERFORMANCE OF THE WONK FOR WHICH <br /> THIS PERMIT 18188UED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO W OMMAN's COMPENSATION LAWS OF CALIFORNIA.•COMRACTOIro HIRING OR SUB-CONTRACTINO SM NATURE CERTIFIER <br /> THE FOLLfC ;:;TTHATl IN THE PERFORMANCE OF THE WORK FOR WIMH TRIS PERMIT is ISSUED.1 SHALL EMPLOY P'ERBOMB SUBJECT TO WOPSOAAR•e COMPENSATION LAWS OFCAl1FORilA- T CA{L24 NO <br /> I� pYrALCB FOR ALL BEOOItmfN NS AT MSJfa.COWCETE DRAWING AT LOWER MEA��fJJ <br /> PLOT PIIAI IOrn.to Sa.rol S.W. •ro �� <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR SOUNOIHO THE FRORATY. /. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> I' 2.OUTLRIE OF THE PROPERTY.OMM OtMERBIONS AND NORM DIRECTION.- - IXPANBION OF SEWAGE DISPOSAL BYSTEIBB. <br /> J.dNAENSIONED GvrL1NEe AND LOCATION OF ALL IX18fBN0 AND PROPpBEp B.LOCATION OF WELLS WITIGN RAp1U8 OF ONE HUNDRED flP1Y FT, <br /> STRUCTURES,MCLUINNO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. ON THE PROPERTY OR ADJoaGNa PROPERTY. <br /> �..... i - <br /> SEE ..AWoci.4c ,/HRP. „..._...__ , <br /> p �Vlue 2-!1. 1495 �R_ .IJCl1 'em '. <br /> ..................:. .._ <br /> iR <br /> : . ........ <br /> .,.. <br /> i .. <br /> ... _.... .... . ' <br /> E <br /> ....... <br /> :,... <br /> ....... <br /> I ! <br /> k <br /> '•oEPARTMFHT usB OIILr .If ••_ //__ .. '---• <br /> AppBe,San Aapepty ft <br /> Rau Irreeeefen Br O.L. PIAnS dwpslten M I� 'F <br /> DH. <br /> mmncdpp I+np-."..8Y jk Joe. , <br /> CmxnpRN: , II <br /> .F <br /> ACCOUNTIMO ONLY: <br /> I <br /> PE CObFi: FEE tlIPO AMOUNT REINITTFS CRECKPICASH RECEIVES BY DATE POWAFDZETRVIC[F EOUEST NMABBI INVOICE <br /> 35vT2 Ceti O' 350 <br />