Laserfiche WebLink
• r .. .....+ u, Y9p n. Gnn uunumn u� . I�n, �n pato rasp <br /> (208) 488-3420. <br /> NOWREFUNBABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> (CGPopIMB is UpliuTE) <br /> APRJCATHN IS HERE W MME TO THE SAN JOAQUIN COUNTY FOR A PETOAIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED.THIS APRJCATION 18 MADE IN COMPLIANCE WITH SAN <br /> JOAWIN COUNTY DEVELOPMENT TITLLE'.CHAPTER/9-1116.3 AN0 TXE STMDAM6 OF SM JOAQUIN COUNTY MOM HEALTH SERVICES.ENVIRONMENTAL HEALTH DIVISION. <br /> JOB MDIESbTIR/AP+NI/6�I.1S/ YJtPI-J CPO LQILC CRV zo-�t /� q P[A-RRCELS�/MNF� <br /> OWNER'S NAME((l++ iCo/// ADOPEBe �o <br /> 3-4)( f.2/0 �di,Cl'F 9Y Lll /RIONE 10'3 y3��3cc <br /> CONTAACTOR J C ) //�Gn�N � MDu6B9a sPJ2�b D,Q. F X//Q41x1 5�L g'I�RNINE; �-77T/7I�/ <br /> SUB CON,,m,fl ✓u/r'V/��A'� /✓O� ��CS. ADORES � PHONE <br /> TYPE OF Wf1LPUMP: ❑ NEW WELL ❑ IvnACEMENt WELL ❑ MONITORING V F ❑OTNFN <br /> ❑ INSTAJU T=N ❑WELL SYSTEM REPAIR ❑CROSSLONNECT REPAIR ❑ VAPDXEJRRACTIONWELL• J <br /> ❑N-13R .IT N.P. OEFTH MUPSET_FT. FIRST WATER IEVFL O <br /> 1iY{E OF MMM �j C <br /> ❑ OUT-0FSERVKE WELL ❑ GEORIVSICAL WELLI X SOIL BONG J <br /> ❑DESTRI/CTpN: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SMIRCATON! A <br /> ❑I�/INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION 'p NJ DIA.OF CONDUCTORCASING N//� 0 <br /> p DOMESTIC Y ATE ❑GRA f PACNIBRE TYPEOFCASIWISTEFL/PVC N/A DIA.OFW CASING N(a O <br /> ' /� ❑ PUBIK:mumcim ❑DRIVEN DFPTHOFGNOUTSFAL SS SPECIRCAT"'N naJIA R <br /> �/ ❑ IRIOOATgN/M ❑OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME JY-IL•MI'40 • CkY')' f <br /> 7 ❑ MONnOPoNG C Y GROUT^ PUMPED: Y. ❑N. CONCRETE PEDESTAL BV OPoLLER:O VruNe S <br /> APIAO%.DEPTH .7:/ LOCKING CNEBTFA BO%/STOVE RPE 01A S <br /> MOMSED CON6TR1/Cl10NAMEWNO METHOD: MUD PUTARV AIR WTAHV____k__AUGER CABLE OTHER <br /> I HMSY CERTIFY THAT I HAVE RIFPAREO THIS AFFLCATION AND THAT THE WOM WILL BE DONE IN ,CORDANCE WTTN SM JOAnUIN COUNTY ORINNANCES.STATE UWS.AND RI/lt8 AND <br /> REGUTATION6 OF THE SM JOAQUIN COUNTY. NO ME OWNER OF UCENSEO AGENT'S SIGNATURE CERTIFIES THE FOLLONANG:'I CERTIFY THAT IN THE PERFOMIANCE OF THE WORE FOR WHICH <br /> THIS F4RMIT I6 IMM.I SHALL NOT EMFWY PERSONS SUBJECT TO WORNMAN'S COMMN{ATION UW6 OF CAUFORHM-' CONTRA R'8 HIRING OR SU6CONTMCi1N0 MONATURE CERTIFIES <br /> THE FOLLOWING: -I CERTIFY THAT IN THE PERFORMANCE OF THE MW FOR WHICH THIS MRMR IS ISSUED,I SHALL EMPLOY MR60N6 SUBJECT TO WdIgANI'S COMPENSATION IAW6 OF <br /> CMMRNIAII 'L <br /> /'/(y��� T CALL M IN ADVANCE FOR AU.AMOURNED 1Ni�lR/ --SAT 1308)488y3. CC/OE <br /> JM% M DONNING AT LOWMIM <br /> ER FA PFOVD. !� <br /> +T %DT RAN IDr.le G l 6..610_ IP <br /> 1. NAMES OF STREETS OR.AMS NEAREST TO OR BOUNDING THE PROPERTY. A. WCATNIN OF HOUSE SEWAGE MSMSK SYSTEM OR MPOWD <br /> 2. OUTLINE OF THE PROPERTY.GRAND NMENSION6 AND NORTH OIMCNON. EXPANSION OF SEWAGE DISH L SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND WCATION OF ALL EX WTING MO% POSSD S. IACAMN OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> STRUMMS.INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVEWAYS,AND WALKS. ON THE PTIDFEIITY ORM XIINING PROPERTY. <br /> 3 .01 <br /> WB ENT LYE ONLY , <br /> APPII�arNr1 A..gtW By G ' <br /> Grout IINP.vtlm By <br /> wu Pune IMpstl.n BY 010x. <br /> o.. <br /> o.pwu.n N.P..u.n Br <br /> c.mm.n10: <br />