Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.opX 388,904 EAST WEBER AVENUE,STOCKTG*95201588 <br /> (209)4883420 <br /> MON REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE I3SUED <br /> (CGmplEtA In TilpfintA) <br /> APPLICATION IB HERE BY MADE TO THE SAN JOAQUIN COUNTY FON A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED,THIS KRICATION IB MADE IN COMRIANOE MH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9 1115.3 A'jN�D THE STANDARDS OF BAN JOAQUIN COUNTY M LIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION, off <br /> JOB AGGRESSION APN/ //// /{III" ��,N� CITY JT�dCI"1��'I PARCEL SMEJAPNF /,3-`^40-0� <br /> OWNEn'BNAME ;kle ADDRI)L EcEJon >¢; ��/If II �A mNINEESI� bIII'STE SIU <br /> CONTRACTOR 2/I Z6!/1 L f /v SSOC ADNE.,215' GJ. /IyY. Loc" <br /> �O (7HkG�c. 97u8 PHONE'k'� 34Fz iE%G <br /> SUB CONTRACTOR�I�01 zaE O( 'eg5go[ ADDRESS II I' LICE Il PHONES <br /> TYPE OF MIJUMMP: ❑HM WELL ❑REPLACEMENT WELL ❑MONITORING NTUL ❑ THE. <br /> ❑INSTALLATION ❑WELL SYSTEM REPAIR ❑CMO..CONNECT REPAIR ❑VAPOR EXTRACTION WELL Er- <br /> 11 Hall <br /> ❑Hall 11El H.P. DEPTH RUMP OR IT. FIRSTWATEn1EVEL O <br /> ITYFE OF RUMP) pE yJ / <� <br /> 11 OUT OF SERVICE WELL ❑M.PHIOICAL WELL I /y BOIL BORNG '/r S II/tu/� •� .AY'H - O <br /> ❑bVIT RUCTIDN: <br /> INTENDED Us, IV"OF WELL CONST AN'T10 EPECHICATIONS II A <br /> ❑imm,K ❑OPINSOTTOM CIA.OFCIA.OF WELLP S DIA.OF CONDUCTOR CASINO N/A D <br /> ❑DQMESTMNRIVATE ❑GRAVEL PACKERS TYPE Of CASINGISTEEIRVG // DIA.OFN'ELLCANM D <br /> ❑PIUWCBAVNICIPK ❑OPoVFN <br /> DEPT OF OflOUf BfK b r MBFECIFlCATION N q <br /> ❑UNNIATIONIAO ❑OTHER GROW SEAL INSTALLED BY 71Y4^IL GROUT BAND NAME_$in Y1II/ce aySfy E <br /> goMONITORING �I OHOUT BFK PIMPED:MY Ya ❑N. CONCgFTf REO[ETALBYUNLLF.[1Y- QNe ' S <br /> AFTOX.DEPTH <br /> AOII'tN� LOCKING CHESTER SO%IETOVE PIPE 4/p//? S <br /> MGMSW CONSTRUCTIONNISWMO MflIbO: MUD NOTARY AIRMTMY AUOEN K CABLE OTHER <br /> COUNTYt IGC <br /> 1 HF9FBV CERTIfV THAT I HAVE PREPARED THIS APPIUCATNON AND THAT THF WON(WILL Bf GONE IN ACCOMANCE WITH BAN AOUIN ORDINANCES,STATE URS.AND PULE$AN <br /> REOUTATIONS OF THE BAN JOAOUIN COUNTY.NOME OMEN OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOVANO:'I COMITY THAT IN THE PERFORMANCE OF THE MNL MR V EMM <br /> THIS PERMIT IB MSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO W ORW ANY COMPENSATION LAWS OF CALIFORNIA.'CONTRACTOR'S HIRING OR BUSCONTMCT WO MONATURE CERTIFIES <br /> THE MU-CVRNG: '1 CERTIFY THAT IN THE PERFORMANCE Of THE WOW.FOR NMICH THIS PERMIT IB ARGUED,I SHALL EMPLOY MAWNS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br /> CNIFORNM.'XIIKMTUCMHF MUST CALL MA IN ADVANCE FW ALL REQUIRED INSPIXTMN$AT I30EI NR-M]S. COM/R�/J/F�-T-E GRAMM AT LOMA AREA Rgg�VADED. <br /> RIB.A /EAG _TIR.��GrXs��i'r s/ Dn.�-l-j7iZ�`7 <br /> �� <br /> not FLM loan'I..1.I <br /> 1. NAMES OF STREETS OR MADE NEAREST TO OR SOUNDINGNOR THE PROPERTY. A. LOCATION OF IRUSE BERME DISPOSAL AS. DR PROPOSED <br /> S. DITUMEMENSIONED <br /> OF THE PROPTUME AN LOCAIVING DIMION OF ALL AND NORTN gRCTION. EXPANSION Of SEWAGE gBMBK AS O FON <br /> f TRUCTU ES, NCLU IN CO ERED AREAS <br /> OF ALL EARTHING PATI AND PROPOSED 6.LOCATION OF WFW WDJON IMG PR Of ONE HUMORED flflY <br /> STRUCTURED,INCLUDING COVERED ARFAB OVCN AS PATIOS,DNVFWAYB.AND WALKS. ON THE PROPERTY OR ADJOINING ROPFRTY. <br /> Z <br /> 1!1 <br /> Lt% 6 I w�j 1995 <br /> f.NV1R(�IVAgEPIIAEJ/E� <br /> .. . tJLI2A41lISFRVI <br /> CES l f1 <br /> OFPMTMMr UAE ONLY <br /> ApplloHbn Alm.lal By D.0 Nr <br /> Or.N Ir.pzHon BY D.0 Punp Irup.cllan BY ON. <br /> Drvwll.n IrApmllan BY Om <br /> Comm <br /> ACCOUNTIN00ILY: AIDI FAC' <br /> PE COOO ME IRO AMOMT REMITTED /C Ml RFCDVfO BY DATE RFTNOTl.g CE MWART NLM$NI INVOICE <br /> b S3 a4V-7 �11197 <br />