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APPLICATION FOR WELLJPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> XON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER <br /> ICompMlE In TrIpRePLFI <br /> AMICATION 19 IMM BY MADE TO THE SAN JOAUUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED.TIIM AMICATION 19 MADE IN CO-MIANCE Wnll SAN <br /> JOAOUIN COUNTY DEVELOMIENT TOLE.CHAPTER B 1115.7 ANO/THE STANDARDS OF RAN JOAOUIN COUNTY FUMM HEALTH SEnVICEB,ENVIRONMENTAL HEALTH DMSION. <br /> JOB ACOM98MM 1A/n,M,I,, Ip/f 11/l'yr 1N,Q.'F fid 4/�Y CITY �iI f y'Yli L(/-n��"(r .}rA//nnCEELL PIMAP41 <br /> OWNER'S NAME 1 o 6aii- l d� I l ADOR£88 � I ` C .�J X0.1 � J/ Imo" r110NE 1 <br /> CONTRACTOR— V I�FIAFro vAE/FArr7>Ic ADIMfPS ,155 Jy 6.{r/ 'J IDCA - MIT (L/i [.\-RIONEI� '',')_L 2.2 ZC)/T <br /> AM COHTMCTOR AD[NRF88 UCI PHONE/ <br /> TYPE OF WfMiTUMP. ❑ NEW WELL ❑ M"CFMENT WELL ❑ MONDORNG WELL 1 ❑ OTHER <br /> ❑ INSTALLAMN ❑ WELL SYSTEM RFPAIn ❑ CODAS CONNECT AFPATR ❑ VAMI EXTMC.WELL 1 J <br /> 11 w' IT DEPTH NMP BET FT. <br /> FM OF R)MPI FIRST WRITER LEVELO <br /> E� <br /> 11 OUT'or"Awe WELL ❑ -TOM WAICAL WTLL 1 Ey ROIL T ORINO <br /> A <br /> ❑DEStnUCTION. <br /> INTENDED UEE TYPE OF WELL CONEIRUCIION EPECIFICANONE A <br /> ❑ INWSIRAL ❑ORNBOTIOM DIA.OF WTI L EXCAVATION .2 F/ DIA.OF CONDUCTOR CASINO <br /> ❑ D0MF9DCMFVVATE ❑DRAM PACKIBIZE TYTE OF CABINRIBIF[LJTNC DIA,OF WELL CASINO <br /> ❑ mstic MUNCR•AL ❑DRIVEN DERtH OF GROUT BEAL YC2 r SPECIFICATION_ <br /> ❑ ISIYGATIONIAO ❑OTHER GROUT SEAT INSTALLED BYll OIIDUT BMNO NAMEyzl E <br /> ❑ MOMTOFINO GROUT SEAL MAIPLD: ❑Y— ♦Y Ne CONCRETE PEDESTAL BY DRILLER:❑Y- (EN. S <br /> AMROX.OEPfN LOCKING CHESTER BOXRNOVE APE /1 S <br /> PROPOSED CONSTRUCTIONR)ALUNO METHOD: MUD ROTARY AIR ROTAR'/ AMER CABLE <br /> I HEAERY CERTIFY THAT I HAVE PREPAMO THIS APn)OAtIVN AND THAT 111E NOR(WILL BE DONE M ACCOIOANCF WITH BAN JOADUIN COUNTY ORI)INANCFS,STATE Uwe.ANO RULES AND <br /> 11EOULATION8 OF THE BAN JOAOUIN COUNTY, HOME OWNER OR LCENBfO ADFM'B RIONATUM CEIDFIES THE FOLLOWANIe•I CERTIFY THAT IN THE PERFO MEANCE Of THE WORK FOR WIRCN <br /> THIS" MIT IN ISSUED.I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMIMFULARN LAWS OF CALIFORNIA.- COHIRACTOR'SHIRINO ORBUB{ONTMCTINO BIONATURF CERTIFIES <br /> TIM FOLLOWING: •I CERTIFY THAT M PIE PERFORMANCE OF TIM WOR(FOR WNCH TISS M"A"T R ISSUED.1 SHALL EMPLOY MASONA SUBJECT TO WORAMAN'E Co.P SAT1ON LAWS Or <br /> CALIFORNIA.- <br /> CANT MW T CALL 3A Ib ULM IN AOVANCS FOEI ALL KEOAARM IN IPECTMnS AT IMSI ASi4IN!". COMPLETE DRAWING AT LOWER AREA R "TMD. <br /> B'w.a ///'L -f�7///lE// nx. A,�i�nEf�r <br /> no RAN AN.1.SP.1.1 R,M. •IS <br /> 1. NAMES OF STREfS OR ROADS FRI TO On ROUNDON3 THE FinDMPTY. 4. LOCATION OF H() ME SEWADE MIRMI AL SYSTEM On Pr otoarO <br /> --- .- Nn,KFEOF-TPRPnQPERTY.ON DAEENMRSANDNORTHWMCTMN, EXPANSION OF*MADE DISPOSAL SYSTEMS. <br /> E. LOQ CAM N OF WELLS WITHIN RAMS OF ONE HUuM0 FIFTY FT, <br /> SE • <br /> 1 <br /> LUSH GEOSCIENCES INC. P <br /> ' WELL FARGdd BANK <br /> i 3560 BUSINESS DRIVE <br /> Your Bank Atldress ^� <br /> SUITE 120 b <br /> SACRAMENTO, CA 95820 <br /> "�///s 4 <br /> PAY 916 73/7/-9294 ebIIB <br /> TO THE pNs E�D 1 <br /> ORDER Or <br /> s <br /> I <br /> ifJ�sf a 3Y <br /> \ AUi NUEp SIGNgiURE ' <br /> II <br />