FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

P.O. BOX 388, 304 EAST WEBER AVENUE. STOCKTON, CA95201388 (2991 468.3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED ICampisti In TTiprmtBl A CATION 16 HERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A F£RNTT TO CONSTPUCT ANDOR INSTALL THE WORK DESCRIBED.THIS APPIJCATION IS MADE IN COMPLIANCE WRIT SAN JOAGUIN COUNTY DEVELOPMENT TIRE.CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY MGIC HEALTH SERVOE6.ENVIRONMENTALHEALTH O SMN. JOB AoomssroR//A��PNN�O /CPN 'fk I�3- D Lo - t I CITY ST{a F;TO'� Q r PARCEL SQVARII OWNER'S NAME Ll-L I N>E✓1'/.I GAL/ Coe ADDRESS 3� INI�DOt.i L1../D N.NI.jn(A Pis N/ PHONE I CONTRACTOR {o•_".•ono--� I^'C ADDRESS ZTl(o-$ /4✓�� Tec,�.�^>Ull Sntr.g GSI PHONE 1-41.5-91 iZ SUB CONTRACTOR lam/ ADDRESS IJCJ PHONE/ TYPE CF WELLPUMP ❑ NEW WELL Cl REPLACEMENT WELL JCI MONITORING WELL/I"w_ IT.I"I ❑ OTNRI ClINS ALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT RfPNR ❑ VAPOR pRRACTION WELL l J ❑N.❑R.P.B N.P. DEPTH PUMP 6ET_FT. RBST WATER LEVEL 0 ^VPE OF PUMP? ❑ oGrCo-6ERVICEwEu ❑ GEowNYslcuwELL/ } Boa BORING ISo s I'l DESTRUCTION: !NTFNDED ULE TYPE Of WELL CONSTROOTION SPECIFICATIONS A ❑ IHmsTmAL `I❑l orEN BOTTOM �I DIA.OF WELL EXCAVATION I I-W DIA.OF CONDUCTOR CASINO D 01 DOMESTTCM VATS Ky GRAVEL PACIUBQE AF IL TYPE OF CASINGMTEELMV SMVDULE 40 I('JC NA-OF WELL CASTING O U T18IJC,'MUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL 5EE ATrl'-AEC G (Q&-E SPECIFlCATTON R :RPJGAT)ONJAG ❑OTHER GROUT SEAL INSTALLED BY GROUT&RANG,NAME E MONITORING GROUT SEAL PUMPED: [3Y- 111% CONCRETE PEDESTAL BY DRRLER:❑Y. ❑Ne 5 AP OX.013T14 ZS A-0 SS PGE)• LoO CHESTER%BoXJBTOVE RPE S momsED CONSTAUCTONIDAWNG METHOD: MUD ROTARY A AIR ROTARY AUGER Y CABLE OTHER HEREBY CERTIFY THAT I HAVE PREPAr EU THIS APPLICATION AND THAT THE WOIK MSU-BE DONE M ACCORDANCE WITH SAN JOADJIN COUNTY ORDINANCES,STATE LAWS.AND RULES ANC i,EGULATIONS OF THE SAN JOAGUM COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT M THE PERFORMANCE OF THE WOW FOR WHIG: 'HIS REPAIR 16 ISSUED.I BNALL NOT EMROV REASONS 6VBJECT TO W011BMAN'f COMRdiADON UWS OF CAIIFORMA.' COMPACTOR'S AIRING OR SUBCONTPACTTNG 6bNANRE CERTGIE� -HE FOLLOWINGG:-II CEERTTIFYY THHAAATT,[UNI�I�IN THE PEPFDRIAANCE OF THE WORK FOR NARK,THIS pE,,,T IS ISSUED,II wALL EMKOY PERSONS SUBJECT TO WORIDAAN'S COMRVNSAMN LAWS O: bmtl x i-� i ICALL]s/1DUR8 IN ,I s (TB AI�l FOR All REOTUF1m INAT� +JG�C �TRTE/—pIAW1HG AT LOWER AREA Cif//�7"_-�(, "/MOTT MN n>,-m 6a.I.l 6c.I. M NAMES OF eTPEET3 OR ROADS NEAREST TO OR BOUNDING THE PNOP'ERTY. S. LOCATION OF HOUSE SEWAGE DISPOSAL BYiTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY.GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION Of BEWARE THINDUMPR DISIL OF ON. J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED 6. LOCATION Of WELLS WITHIN RAIHUB OF ONE HUNDRED FlFTY FT. STPUGTIIRES.INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. ON THE PRDPERII'OM1 ADJOmMNJ PNOPFATY. SSSS... ... I i SSSS .._ SSSS .... .. .. SSSS : SSSS... SSSS. : _. .__. DpM ARTENT USE ONLY APWI..IIw:AP Iw Br D.I. D.R. Pume yvpcUen BY G.wI Imo«tlen ev 7 O.0 FAC/ ACCOUNTING ONLY: AIDl PE COD" FEE INFO AMOUNT REMITTED CHEC" ASH RECOVED BY DATE RgW.DTNSERVICE REGUfJT NUMBER INV OIC£ 0122