Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.o:.v6X 388,304 EAST WEBER AVENUE.STOCKTON,CA y*II388 <br /> 1209)462.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (CTIIOpISTS II 711pDAR1Rl <br /> APPLICATION IN INRE BY MADE TO TIN;RAN JOAOINN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTAL TIIE MX1/K DESCRIBED.TIPS APPLICATION IS MADE IN COMPLIANCE MITI RAN <br /> JOAOUIN COUNTY OEVELOPMENT TITLE.CNAPTERL9-11.176_.3 AND TYPE BY ANOAIIOR OF BAN JOAOUIN COUNTY PI)BUC NEALNI RETRACES.ENVIRONMENTAL HEALTH OMSION. <br /> JOS AIORERSOR MMNl I/��y�n W. <br /> C.RQ r*r we�/ CITf'2\,^ tck'40n PARCEL 1117VAM7I - <br /> OWMPPS NAME )I ILP IJ�U/F�O{ T� ADP.NIERB J rte/ W 'ryry����G�O�P - v",-/ AgNE/1 .1 P O u 'I o <br /> AA t Ge �nvir nEYI 11.IC1� J L AOnMAR 0 W !'Gh.I1�Ae UCC — q6b'' Zb4 <br /> COMTUCTOR LInK O o_e ti I�_3 b 22 PLIOM/ <br /> RVR CONTRACTOR ��s• ,• •, ,1 1- AINMERF. ;lrA�OmL�AK•t�ia:' 1d O 2 2 7 nlol •- <br /> E_ m Prqq R LIMU � <br /> T� �►�-s�s <br /> TVOF WEMP. 13 NEW WELL ❑REPLACEMENT WELL ❑Mowromm WELL E Uq OTHER & TRe bQ <br /> ❑INSTALLATION ❑WELL BYSTEM REPAIR ❑COORS-CONNECT PEPAS ❑VAPOR EXTRACTION WELL I J <br /> ❑N..Y 13 n-.4 H.p. DESA NMP SfT�R. FIRST WATER LEVEL O <br /> (TYPE Of RIM% �T <br /> ❑OVfAfRF.nVIr.E WELL ElDEDn1YFTCAI WELL I � SOB.BOTSNO _ R <br /> ❑DERT RUCTION: <br /> IN I ENDED USE ITFE OF WEAK CONSTRUCTION SPECT ICAIIONS /E A <br /> ❑INOVSTRTIAI ❑OPEN SOrTOM DIA.OF WEII EXCAVATION . Z DIA.OF cONOUCTOR CAMPY VA— D <br /> ❑DOMFSTICRTBVAIE ❑mUVFI.PACK/RUE TYrf OF CAPMDIIIIYET WVC N/A' MA.Df WFI1.CASIND A. O <br /> ❑MAT ICNAUNN;R•AL ❑MSVFN DrPlll or MV/TT REAL 7.4�I Dro+VN Rm "MAY IT -T� .PLr 1R <br /> 0 UMNIATION/AG ❑OTHER OIMIIT SFA.MSTAI.LFD BY )gf EET�TL DROIT BRAND NAME -I bI1131 CTT4PC N CrWAfE <br /> ®MOMTORINO ' OTIOIIT RAL RIMPEO:❑Y.. IB ff. CONCrWTE PEDFSTAl RY O MLER:p1 Y.. ON. S <br /> APPROX.Of."" � LOCXINO CRESTfR ROXI TORE M4 V S <br /> PROFORDCONBTRUCTONIOMWNO METHOO:MUOROTARY ARITIOTAm AIIOER CAME O1/IFR �TPo ,�Q�Q <br /> I IIMRV CIT IIFY THAT I HAVE PREPARED T/NR APAJCATION AND THAT TIIE WORK WILL BE DONE IN ACCORDANCE VATTI RAN JOAOUIN COUNTY ORYANANCES.STATE LAWS.AND MULES AND <br /> PFOLNATIONS OF TIIE RAN JOAOIRN COUNTY.HOME OMmET OR LICENSED AGF./T'E RIDNATURE CTI IRIE6 TIIE FOLLOWING:'1 CERTIFY THAT M TME PE/rORMANCE Of TIIE WORK rOR WNICN <br /> TIPS PERMIT IS MOVED.I STALL NOT EMPLOY APRONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.'CONTNICTOR'S HASID OR PUR.COMPACTOM BIONATINE CETTRIES <br /> TIIE FOLLDWMNO: 'I CERTIFY THAT M TIIE PERFORMANCE OF TIIE WORK FOR MASCOT TINS rFnUrT IN ISSUED.1 SPALL EMPLOY PERSONS RUIIJECT TO WORKMAN-11 COMPENSATION LAWS OF <br /> CANOIWIA.• INS APPUCANT MUST CALL IS HOURS IN ADVANCE PON ALL MOONED INII/CTDNR AT 1""441I40I71.COMPLETE O AMAN I AT LOWER ATEA/110VIOF.D. <br /> ,,-w X /,`,)cIA , � TIO. S 4 4 F F L 0 -2 S-4 <br /> PLOT PLAN fm—I. <br /> R..I.1 MW '1. <br /> 1.NAMFR of PIRFETS OR ROAOR NEAREST TO OR ROIRIDNIO riff PMPFRTY. 4.LOCATION Of IIOUPR SEWAGE 010"OSA SYRIFM OR 11"PORFD <br /> 2.OUTLINE OF TIE 1`4110rff".DIVNIO MUFTIMONB AND N011T11 INPF.CTION. EXPANSION OF BEWAOE DINPOPAL SYNT EMB. <br /> �.DRATUMOMD OUTLINES AND LOCATION OF ALL EXIRrINO AND PROPOREO S.LOCATION OF WELLS WTNIN RADIUS OF ONE HUNDIIEO TMTV R. <br /> STRUCTURES.INCLUOMO COVERED AREAS SUCH AS PATIOS.ORIVEWAYR.AND WAUCS. ON TIIE PROPER"OT ADJOININO P"OPEIT/. <br /> WoaK : f/cEnj <br /> Oa <br /> 171 <br /> ..............:..... ................................. . <br /> PAMfMENT TME OTKY <br /> ApPft Wl—A ..BT Q J Aw <br /> M«11 MwpI�N«I BY O«. n!«P Uwp.Mwn IY ON. <br /> D..InwNen Lww�nllen SY D«. <br /> ACCOUN11N0ONLY: Aro! FACE 1 <br /> FE CODES FEE INTO AM T REMITTEDCITE /CAIN RECEIVED■T DATE ►EIPAOTINITPACE REOUEST NUMSEII INVOKE <br /> r or. <br /> Pub.Health Serv.-E/Wiro.173(3/96) <br />