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SAO]JOAQUIN COUNTY PUBLIC HEALTHY YICES <br /> DIVIROUMENTAI HEALTH OIVISIOU - r- <br /> P.O. BOX 3881374 EAST WEBER AVENM STOCKToK CA 9MI,388 <br /> ttov)400 130 <br /> 8omeEuRaAlj9 PED srt <br /> APPLICATION M WM By MART TO TNI SAN JOAOUDI COUNTY FOR A PFFOArt TO CONSTRUCT A! ALL TM WOIIC DESchMIM.TICS APPLICATION It MADE IN COMFUANCE WITH am <br /> JIM AoonEOUNTIMM �OPh�JT_ �fTU CN TVA O-1116.J AND THI GTANDAROS Of OM1 JOA MM COUNTY PUCLIC HEALTH CEIIVIC[�AL HMT"Omt..q . <br /> A/^IM/� /�nN��J// aITY�^/'� /►�A..1 lM6rAwa <br /> OWNM 1AMGE ArAXQSSTIONS.— <br /> coNTRArtoR ADO LClfryZ�� / `^ 3 <br /> VXI CONTRACTOR ADDRESS_� _ r7'�— LIC• 2AtDN!/� y <br /> n,Pg o►Tyet r D ww WH.L D FW%AC aNT WELL D "aw" om WEU.• DOTH9l / <br /> D VNITALLATION D WELL UMUM REI-AMD cmcsc�mmm 0 VAPOR EXTRACTM WELL. ,! <br /> ❑N.w D R.FSO+ N.P. DEPTH PURL►CET FT. R°W ATER LEVEL _ O <br /> RY►'E OF FUTAL7) <br /> D Om4wc.mm=WILL ❑aObltilvR7CAL WELL• eeoa.COR'Aie ' e <br /> D OEarnuctroFL <br /> D ROUCTFJAL D OPEN COTTOM GIA.OF WELL EXCAVATION GIA.Of CONDUCTOR CA6M O <br /> D OOmEIITICJFRTVAn ❑oRAVEL PACKmu TYPE OF CAommmi EB1►VC�• OW OF NRLL CA'M O <br /> ❑PUM1CIMIN6WAL D oRIVNI DwtH OF ORMR fmAL � ITFlCtT9CAT1ON R <br /> D atlCOAT owm ❑oTNE11 GROUT WAL DWAUJMD IF •i GROUT WLAND NAIAT < E <br /> D MONRDIC" oROVT DEAL vuumD:D Y« N. CDNCIraTE FmsaTAL ev Dkutle❑Y« Oft a <br /> APVMX.ecstH LOCKIM CHECTm COXO*WVE FOE S <br /> MWPMW eO=Tr=TXKVV=LLlr=METIIGO: MUD ROTARY AR ROTARY AUOE11 CATS O <br /> 1 IF-411Y CERTIFY THAT I NAVE 1'AEYIJIEU TMS AIS'UCATION AND THAT TIE WOPK W41 GE DONE IN ACCORDANCE WITH STAN JOACUM COUNTY OROMANCIC,UTATI LAW*.AND FlUl"AND <br /> RFOUTATIONS OF TIE SAN JOAMM COUNTY. HOME OWNER OR LICENCED AOENT'a ORWATUIRIE CERTI M TW FOLLOWIW!'I CERTIFY THAT IN TILE PERFORMANCE OF TM vJm FOR WHICH <br /> TMS PERMIT 13ICOUFD.1 SHAIIL NOT EMMJ"MA3ONC SU3ACT TO WOMWAWS COS0C=ATNW LAWS OF CALWOMAA,• CONTRACTO"04=4 OR Gq-CONJRACTINC 02HATUOM COOT MIl <br /> THE FOLLOWING: 'I CERTIFY THAT M THE PERFORMANCE OP THE WORK tOR WMCI TM MDVXT I*UMUTO,I CHALL EM OY PDNVONC aUWWT TO VJO=aAAN'S OOUpOS9ATIM LAWe OF <br /> A=—MpT"LOT C W AOVANCG FOR ALL F12OICHM IMa AA <br /> OW T CSCOR�CmaMSS C M T LOW=ARIA W/ <br /> X T ( u.. �— <br /> PLOT PLAN CRnw..a."a.r. •I. <br /> R. %AMID OF VTRWTC OR FLOATS NEARtat TO OR DOUNDOM THE PROPERTY. ♦. LOCATION OF HOUCE C2WA0E OICPOOAL 9YUU M OR FRAPOM <br /> S. OUTLDIE Of TIE PROPERTY.GIVING DIN EICMNS ANA NORTH OD@LTION. WMANCLOFI OF WWAM DIRPO*AL CYWV". <br /> !. bNAPI M"OUTLWM AHO LOCATION OF ALL EXWrM AND PROPOSED C. LOCATION O►WEUA WIT"RADIUS Of ONI HUNDRED FOW FT.* <br /> STIUC UM.INCLUOM COVERED AREAS SVC"AS PATIOS,ORVIWAYC.AND WALKS. ON THE PROPERTY oR ADJOPON FROPEATY. <br /> :.....;_....: ...... . <br /> MAP ON' BACK �, <br />