|
3-25-1996 3:00PM 1-Kum
<br /> e ,
<br /> �•' i ; AMYLIUAI]UN FUR NELLIPUMP PERMIT
<br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES
<br /> ENVINONMENTAL HEALTH DIVISION
<br /> ! i P 0 BOX 398,446•N,SAN JOAQUIN ST„STOCK70111,CA 95201.388
<br /> (209)4SM20
<br /> NON•AEFUNOABLE PERMIT EXPIRES T YEAR(-AOM DATE ISSU�D
<br /> ---
<br /> �,� Apoticwjion:is hEr DI(TgRdV to tki sen Joaquin County for a permit to construct and/or install the wrk described. o0s appl[citian is
<br /> . •nde'irt!ca;rplisr�e:r,th.i?n JtraquTn e«ntyOevelopwrit Title, chapter 9.1175.3 and the Standards of sen Joaquin eou+ty►ub(ic Nit it
<br /> Serv',•f4, Envlro}taeritafj ealtII Oivisioors. 1
<br /> Jobs Addn4ss/of '311.' ]C? S C tQ1lQ.` '
<br /> i- Y, 1 City
<br /> T w ►arcet She APusi2i►
<br /> 1 W-Mcf- 2/l
<br /> �tba,'et"?:•?roine'I1'� :V.b`'tiw.�•�. :(-{pot�C�v�.AddresR-j��Z.is V�� •••� t/� v I , T"�'—^r-.
<br /> Con s—P,�'i�TlXC� .,ynC. Addresd�)�y0 D Z�r«►'��r1 [•mss l Ito 1 i.
<br /> ' anone Rau
<br /> ':subCont rcfoi• i. i�. [ulIi_ o (Cao) z0=o21Addre -
<br /> nw Cd
<br /> Z
<br /> :7YPE'OF WFLL[AtNIP (f:M 'WELL'-: [I REPIACENENT WELL []
<br /> NgNITt1111NO YELL ! •0 OTBER• .'
<br /> $TRUCILoa:•, p WT-OF•jERVTCE WELL [I GEOPRYSICAL WELL-N_' EI'SOIL BORING
<br /> !1rSYALUlT101(,• (] WELL SYSTEM REPAIR 11 CROSS-CONNECT REPAIR (] V",EXTRACT ION LA ll !'
<br /> I' I' [I. er I7 Repair NLP._. DEPFA PUIM SET FTPUMP) , ' fIAST HATER tEJEt
<br /> i 1' �'•s�e-�{!�Y t«r �ii Mw—f tNw-2a nAVJ-3 a—Mw-1{
<br /> IMTCMDED:1isE';. T � _ :•CONSYROCTIDN sPj}TFTCATIONB
<br /> -I] INDUSTRIA: I'•.. I:.! - ;
<br /> 1, [I!: I;N�IIGTTON' DIA, OF WELL EXCAVATION DIA.:OF' i
<br /> f i•' COADtIC- CASING
<br /> {11.00NE3't'1C PNfYAlf•'LIII.AVELi PACK/SIZE TYRE OF CASING/STFEC/PVC D1A. OF ML CASING
<br /> PUBEIG/NONJCI?PL�r.bj-0 LYEN. DEPTH Or GWT-SEAL SPFG1ElUY1pM.' ,
<br /> i.(] fRA7GATTQN/ACID.: •pj'OTNEA; - UGUT SEAL INSTALLED BYC(�Ux'BRANO NAME l
<br /> -.:t7 NONJIORitt6: i. i I; GROUT SEAL PUMPED: [I Yes [7 No CONCRETE PEDESTAL RY DRILLER: p'Yss I]*No
<br /> '
<br /> -APPAO7I:DCPf•11 •=�I'.-1'''y„� : LOCKING CHESTER BOA/STOVE PIPE •- -
<br /> 1 L:
<br /> '►ROPOSEu tDDISYRUF1i0NI0}LUL�I1D fi"Xdv: )RID ROTARY__ AIR.ROTART. AUCE1t_CABLE OTNfIt
<br /> t ngrebylurc,i,l.Yjthe�-!I ve prepared thio opptie•tion and thoc the or
<br /> Witt ne gore in'ebcorow1ce with Son,Joaquini CoauyOrd n•nces,'
<br /> .':SEitd lett„;eri0; vte3 and Re.Owtetiorn of-the son Joaquin County. Now osner or tiosnsed oventfs-siwotu•e eertifi."j the followim. of
<br /> 4iO th'ot•iA.tt�iise-fb ... e:af.tlje_4ork,foo 4.140.this permit is fsswed, I shatl.hot amptoypcf;om'sidrject to:tA7RKfUW'SCONPENSATl011
<br /> sc;;of'Cal'fif”?rireE^-_'s vactora hiring or';sub-contract:in9 signature certifies,tho following- 'f!' I-certify that Tri the perfQrmwtce•
<br /> --:of•Cht:trtirk%f '..- 4 •t'is tis=lssuo I nail y,persons subject to wORXMAN'S cowmigiou haws of Califorj,fa:• TNEAPPLiCANT'
<br /> 6 YA 0 lt:R IR KC 0 T 01I 186.3427. Gortltote drovinB ai todl%c aree'probided. '
<br /> is
<br /> Title
<br /> •',�.• ' I •,. .r�:1 - P?T;PLAN Coraw to$Cala) Scat--L-- to - - - '
<br /> `� ':'t.-=NYmq •of,g.trcves,v.R�+:otda;tieare>t:to'ortpvrllras the:property. L, lecvtion`e1 hgKe scNape dlipbsat'syicem'oF-
<br /> •,�2: lfnr o4:•tlj<,Frogertr.Y,_ q;.vi�q;YllrAens Eonf,and=Jlortb direction. proposed:expansion of.FewoOC ftisp"al'W"tewa.
<br /> �3.•.-Di
<br /> $1 .-out( Nd:tocat.tion of•olt,exastllm"proposed, S. locution-•of Welts>rijbin rodiw:.of_150 ft. an r
<br /> �c.t!uctui•rs,,IOeludf[;pI{'cover0d•'areiS-tuck;es.patios, drivestays,
<br /> the'property or pdJp(ninB property.
<br /> :endtSal`Ysi r: :1+•I.'r I - 'I .
<br /> •i : s� �:
<br /> >I r4V
<br /> '.. ',• '`{. >.,.....,...r ,yob '�
<br /> •-Ii• ! DEPARTMENT DST OWLS "''°r•• !
<br /> t i��tljjI;, JAcctp'ed It
<br /> Area
<br /> 1,.
<br /> Grout fn; vionl[ly - ' Data Inspection " Dace
<br /> ., i ' ` Pump By
<br /> .i : - i
<br /> :io stru2tt:ai�l'nsptSii;oril6y°..'. .. . Date Comilento:
<br /> 1777
<br /> "AtCOUIITIIYO,.ON.If2' tt JIIDJ<i'-•• FACS '
<br /> :. •
<br /> `tC rt:O Eli :Ff'f;iNFO;I-J1tjt0U11T.0[u1TTEb'- 'GI CJISIt• �AECOVCD AY LATE -►ER]t17jSER11)CE,REROEst'l1UMBER' •AYOIb�'•.;, '-
<br />
|