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! AI'YLIUAIIUN 1-UH WELLIPUMP PERMIT _......
<br /> 1/ SAN JOAUUIN COUNTY PUBLIC HEALTH SERt2t1:S
<br /> ENVIRONMENTAL HEALTH DIVISION `
<br /> P 0 BOX 389, 446•At. SAN JOAUUIN ST., STOCKTON, CA 9L201.389
<br /> I 1209) 468.3420 '
<br /> ,, I! :' i NON•pEFUNp�bIE PERMIT EXPIRES / Y
<br /> AN FROM DATE ISSUED
<br /> i I! •ii I
<br /> i ` I 1 •1 ' (Complete in 71 11e■p) '
<br /> App.t►ctrgi.ori:is hF;rc by, We to th'e•Son Joaquin County for a permit to constrict end/or install the work described. This application is
<br /> made in.!complianCe!Witli -.$an Jbaquin CountyDevelopmcnt Title, Chapter V-1115.3 and the Standards of San Jba in Cow
<br /> I, Servica>z, Envlrohtaetitail 1lealth Division. qu tt Pub
<br /> I Y tic Health
<br /> Job*
<br /> •Addresi/or ArNX CJ17' � I.t/.'Chow tr:R
<br /> -"` City Y'7LG ) 3
<br /> Ze/APNNi214-/$O-yz/�
<br /> a•ltoine_, '¢ HtidH 1.,' Parcel S '
<br /> .Address !1820 1).L
<br /> 9''/5-68
<br /> B Its CA:
<br /> I;' ,.i;Coritractpr: f'✓asea', H,�, : , r sBo N. 9y St, : Phon� N Slo .829-849/:
<br /> • i: ,• . Adi.reea Sz►, Jose cA 9S-1 i Z. +
<br /> ' p L i c# PhonE953-/j8p
<br /> I' Sub Corii nGtOi (�i'q•It ilk 1'' p1'�fIIH Address K l"mand D '
<br /> 1730 a ., i
<br /> u✓ oc 9 3 z LicrY� 5 673SQ�j Phone �SpO 20I-c21)
<br /> • :TYPE_'0_ F_itEll%PUMP!: ' tN N'>lEll•' p REPLACEMENT WELL i
<br /> ! X MONITORING WELL L_ [.) OTHER 1 ,
<br /> STRUCIIOH :OUi-OF-SERVICE•WELLS p GEOF'IITSICAI WELL N i
<br /> '. X SOIL BORING` 4
<br /> [ INSTAIIAYld1t (] (/ELL SYSTEM REPAIR I-"�—
<br /> I+ I' • UCROSS-CONNECT REPAIR
<br /> i. : 0 VAPPR• EXTRACTION WELL N'
<br /> [] ew Sl Repair N'.P. DEPTH PUMP SET `
<br /> (TYPE OF. 4P) „-�FT, FIRSi NATER LEVEL
<br /> 21 .
<br /> 1
<br /> •CONSTRUCTION SPEL'IFICATIONS
<br /> .3 11 INDUSTRIAL." .; I — 8 rl
<br /> U 0 EN NQITOM ' DIA. OF WELL EXCAVATION DIA.; Of. CONDUCTOR CASING y10Nt?
<br /> [] .DOM(ESi(C/PRIpATE:' I]I!G AVEL;`PACK/SIZE TYRE OF CASING/STEED/PVC PVC i
<br /> " '':; ! DIA.:OF WELL CASING 2
<br /> I• "iU Ousuc/mm!IC1Phl rj]�ID I•VEN : DEPTII Of GROUT SEAL 2 � --
<br /> SPEGIFICA lok,'sclw' . b PV C
<br /> q 1RR1CATtON%AC 1i P flame
<br /> :. • •1.1, . I . Q HER ; '4ROUT SEAL tNSTALIED BY �rON 2r Urllie9CROUY'GRAND NAt{E ' I pr
<br /> i ;• I..06111-1 IkG` ' CROUT SEAL PUMPED: [I Yes )4 No CONCRETE PEDESTAL BY DR,jILER: I] Yex''q'No j
<br /> . iAPPROX.:dEPi11!_ I _ O,I ;.I LOCKING CHESTER BOX/STOVE PIPE S VQ P
<br /> FROPOSEOICONSipUFT10NJD IL. NC METHOD; •,MUD"ROTARY_`.;AIR.ROTARY_,--,- AUGERCAOLE,_,-_ OTHER '
<br /> 1-
<br /> ' I herebyjccrt+ay:'that, llh vN peep@red this application and shot the work wilt be done i.n'eccorderice with SanlJo�aqutn County0rdin■nces, '
<br /> Is.
<br /> Layq,:;and; ul'et and ilcgu�ations of-the ton.'Josquin'County, Home owner or licensed egent's'slanature cdrtifi.e:sithe following: "1
<br /> ! •;cel fy th'at::tb:th;1.001' r nce:of.:tFje Nork,foe wft'ich this persalt I's issued, I shall.not employ peesvns'sid�ject tv.WORKNIIN'S COMFENSATIOH`
<br /> for•nie !'•"•;C tkaetoN;a Nor
<br /> or"aisle-contrect:itg signature certifies:the following: •„ [ 'certify•that'.1-n.the performance
<br /> I• 'r.
<br /> �: •,ridf thl•,' prk%(or;srhji�h tljis Iiermit''is:JssuGO, I :shall *ploy persons subject to WORKMAN'S COMPENSATION laws of:Cal ifornia." THE APPLICANT
<br /> 1 Mµ&Ti011.114,
<br /> All 24Ill al'y
<br /> wA CE`FOR�Al'i:pEUU[REo SPEC IONS AT(201)468727, Conplete drawing at lower eree'providcd,
<br /> 1: Title SICNIOR ••GEdIOC,tST' pate to�3 y
<br /> .`F-INA R DI : E• RO A / TERRA E laic,
<br /> PLQT ';PLAN (Draw .to Scale)-Scale M co_ 40 S ARCtt�
<br /> %1,: Names oE.i:.ticet•s.'o.F�roeds':'riearis°t•to or bounding the:property L. Locatjon `bf house sewage clic
<br /> 2, •Outl'ne;of' tlje;pioper y rvi posal'systera'or
<br /> i' ,: g, nq;dltiiensi:ons,end.+North direction. proposed:expansion of; sewage,disposal' systems, '•...
<br /> 3- •.Diirw-tjsiolred cjutlines:li ';(.gca.tton of 'all existing arxf.proposed•
<br /> �SCruc.tur anclixl ny covered-'a�etis such ;as,patfvs, driveways, S• Location•of wells Wlthih rodius::of;150 (t. 'on
<br /> ` :and,'t�ellis� `' the property or BdjoSntng property.•
<br /> Its
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<br /> � ' I, t� i ' �• DEPARTMENT•USEONLY
<br /> Aol;-Ica( on'A�cceplted
<br /> . ,, 1!•: 'I, bate" Area
<br /> .. Grout. pact+ton
<br /> �.. (•iY ;' ; '�� - Date�� pimp inspection Ry
<br /> , t Date
<br /> ;•; .:DesttisCt�.ork:.liispectiorilsy. i !
<br /> ''!• �• i`' �I 1.. :i. :Date Co:nAents: �..
<br /> �,; �• 'ACCOUHi1N0:ANlf '�i•ii."� AIDIY: •-• F � -•� (�••� ),, .
<br /> ACN
<br /> PE.GD' s! ''F INFO!' ?A oUNI.Ri MItTEb'• ; Clt[Cfl%(CASIT' :aECEIVEO;BY DATE PERMITJSt RV1OE PEaIUESt'NIIMbEp! trYD1GE'
<br /> `,.. y7 '
<br /> ,' 7 7, I
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