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APPLICATIONFOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES - <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON.C0�1-88 <br /> (209)402.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (CRNIpIEI*M TrIp6F*1.) <br /> AMICATION It NF.RE KY MADF 70 TOM RAN JOAOUIN COIINrY TOR A PERMIT 10 CONSTRUCT ANDIOn INSTAR 7/1F WORIC DESCOSED.TINS APPLICATION le MADE IN COMPLIANCE WN11 SAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE.CHAPTEREt9.1116.3 AND Tilt STANDARDS OF RAN JOAOUIN COUNTY nNRLIC NFFALTN SERVICER.ENVIRONMENTAL$WEALTH DRISION. <br /> JON ADDIIESSATR ArNs I SV ] W. GRA der WOY CITY_ Sl-c w 4Por) rAnCFt RIZEMMI <br /> OWNER'*NAMEI 1 IG rC?\`VU f n- T! A—90� I � YO3 W - r-14cif+(r}WG / <br /> CONTRACTOR �']� � <br /> . G/ �C(A, n1oNE F ( �1 D 3 Y O <br /> I1CF ZZ n10NEl qS hozby <br /> /N �1 <br /> SIM CONTRACTOR AODIORR:t�IS �- tFgqYgn' , iRR22 nrol4l��9�T5/S� <br /> TYPE OF WELL/PUMh ❑NEW wat 13 REPLACEMENT WELL IJ MONITOR""WELL l yq OTHER 6l a TQn pQ <br /> ❑I/sm-1 � <br /> i ATION D WELL SYSTEM RErAln IJCRORS-CONNECT REPAIR ❑VAPOR EXTRACTION WM l <br /> RIPE OF%/M% 0 <br /> /M% J <br /> ❑N-13n-.p ILP. OF"ll mwr-SET_ FI. FIRST WATER LEVEL D <br /> ❑otmor RFRIVICE WELL 13 OEOn1YNNCAL WFtL/ 10 ROK*ornIO Z R <br /> ❑OFSTRN/CTION: <br /> INIFNOED USF TYR OF WELL CONRwtFclION SFECIFICATiONi <br /> ❑INDUSTRIAL 11 OPEN NOFTOM DIA.OF WELL EXCAVATION I,' l DIA.Of CONDUCTORCASNIO 4pJI# D <br /> ❑MMFS/ICMMVATE ❑nRAVFI.rACK/NNE TVrr Or PA9lNn/NiTrt R•Vf: Ajlij 1RA.DF WTI CASINO /L,IrT R <br /> ClruinirMUTSf:trAL ❑f11KVFN nrrt Nor OMIII RFAI ;4I I 1>&I •_\ SPECIFICATION (� N <br /> ❑RNRCIATIONIAO ❑OTHER SnoUT SFAt.IHSTAI.IFD.ITT <br /> NMNO NAME 'I L Ji�tt <br /> ®MONITORING 'T OMIIT IN AL PUTAPFO:❑Y,. ®N. CDNCDETE PEDfSTAt 9Y DR tFR JR Y- ON. f <br /> LQ' <br /> APPROX.OFITN LOCKINII Cl/S01Fn ROXlRTOVE nP4 V!• S <br /> PROPOSED CONSTIUCTIONIOR HUNG METHOD. MUD ROTARY AIR nOIA11Y AtIOER CAIKF OTIIER�eo Fiobe <br /> I ItMRY CERTIFY THAT I HAVE PREPARED TINS AITLJCATION AND MAT 111E WORK WILL RE DONE IN ACCORDANCE VAIN SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES ANO <br /> RFOUlAT10NR OF TIRE RAN JOAO"COUNTY.HOME 0W 511 On LICENNFD AOFNT'*RNINATUnf CErowlE0 TIIF FOLLOWING''1 CFI"IFY THAI M THE PERFORMANCE OF Tof WO/K FOR WINCH <br /> 7108 PERMIT M fSSUFO.1 SIAIL NOT EMPLOY PERSONS SUIIJF.CT TO WORKMAN'S COMrFNSATON LAWS OF CALIFOR IA.'CONIRACTOn'S Nomm OR RUN-CONTaACTom SIGNATURE CERTIFIER <br /> TIIF FOLLOWRNO: '1 CFMIFY THAT IN TIN RM OF TIIF WOTC ron mach WIN*mmm IR ISSUED.1"WALL EMPLOY PERSONS RUMCT TO WORKMANS' COMPAISATION LAWS OF <br /> CALIFORNIA.' THE APPLICANT MIST CALL 21 HOURS IN ADVANCE FOR ALL nEOUMWO INSPECTIONS AT 1]0014/03021.COMPMf DRAWING AT LOWER AREA PROVIDED. <br /> SlYn.l X //,Nw&_I a• L.a lA._ nx. S 4 4 F f' 6e o l o�� / On. 19-25--q4 <br /> - <br /> PAT PLAN OI U S.d.l Net. 'to <br /> 1.NAMFS of eIRFETa On nOADR MATWIlt TO ON SOUNCO a 111E PR/IERTY. A.LOCATION OF NOURF SFWAGE DISPOSAL SYNIFM MI PROMSFD <br /> 1.Ot"Emn OF 111E PROPERTY.GRRNa DIMENSIONS AND NORTH DIRECTION. EXPANSION OF*[WAGE LIRMSAt SYS7EM0. <br /> �.Off"NRONED OUTLINE*AND LOCATION OF ALL EXINTINO AND PROPOSED i-LOCATION OF Witt*WIVWON RADIUS OF ONF HUNDRED FIFTY FT. <br /> STRUCTURES.*KtUOIIIo COVERED ASEAN SUCH AS PATIO*.DRIVEWAYS.AIM WAtXR. ON TIIF ITOIERrY On ADJOINING FTIOPENVY. <br /> SCL WORK 00' <br /> Qa-lfD z S ID ne tai b <br /> 17 <br /> DFP—TMFNT USE ONLY <br /> 7 <br /> APPN..IbO A...SIM 171 Ow. iD G A... <br /> or.,,r irw0wxen ST On. Ib•••P#--I—RT Ow. <br /> O+InwINn In,r.alle•,AT Dn. <br /> ACC.UNNNO OMT; AIDE rACI -- 1 <br /> FE CODES FEE INTO AM T RET.IITTED CITE MAill RECOVED■T DATE 1•17IMIT/SE7WICE REQUEST NUMR91 INVOICE <br /> Pub.Hearth Sem.-ErpAro.173(31%) <br />