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f APPLICATION FOR WEWPUMP PERMI <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SEES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ra BOX 3%804 EAST WEM AVWM gTpcKrpK CA Mol.,%8 <br /> I2019 468.3420 <br /> NOMMMDASLE PEIM1i Plcanee "r•R fw09 DATE ISSUER <br /> APPLICATION is PIERS S1f MAOE TO TME SAN JOApErN COUNTY POR A PERI MT TO �gfLb M Trwmb) <br /> JOAOUM COUMY �rISNCT ANDIOR INSTALL THE WORK DELL N BW TNSL APPLICATION is MADE IN <br /> COMPLIAMCE WRAP sA►+ <br /> OEVEE•OPL sa Tom.CINAPM 9.1115.3 AND TME STAMOARpS OF LAN JOAOLrN COWM PRISLIC <br /> HEALTH LERVICEt.ENvaRotalPxrAt HEALTH <br /> JOS ADO MSSAM AIM Am CRY e'l ., ,/ <br /> OVVNWl NAME /pN PARCEtL'SMAPNP i y fFC. <br /> G <br /> r ADWSS �, L!,36 <br /> CONTPACTOR=&—�-- / PHONE — 7.7 <br /> r �c�011 <br /> txs PIWw* <br /> SUS CONTFACTbR <br /> ADOrd <br /> PHONE <br /> 7710E OP WEi•SPL O NEw WEL O PEP App WELL <br /> Cl M01SrONNO WELL I D OTilEil <br /> ❑SNSTAIATION O WBL LYLTEM!@Art Cl ewLL4Aw ear REPAIRVAPOR vcrµcrwN wLEL <br /> O ❑ M <br /> N.w Rqi J.� Do"PUMP LEr .R <br /> �� POW WATER tsvEt o <br /> O ouroN_LE1tRrICE wEtL O oEOPMYLICAL wEll. LDL.LDNRrNo <br /> O DEiT1iJCTION: i <br /> O mugr1EAL ❑OPEN ORA.OF WILL EXCAVATION w. A <br /> O 001MIXI CONNATE O ORA PACKMU DIA.OP CONDUDTOII CASM 0 <br /> O KI LICAll" VAL ❑ TYPE OF CASV4W L#vC DIA.OF WELL CASINO /I,G1" 0 <br /> DEPTH OF GROUT SEAL t: tPECr9CAT" <br /> O /!�' <br /> pamai0WAD 13 O WT LEA,■STA �I/IND NY I.�' e <br /> 13 aROVr BRAVO HA1Nl <br /> I#plrroRrIO e <br /> APMIOX. <br /> �, GAOW SEAL PUM lm p Y.. ClM. CONCRETE PEDESTAL iY D aLm O Y.. ON. s <br /> OVfN_` l n 11LOCKING CNEirEll rOXIfrOVE PIPE <br /> PROPOSED CONLTIINC710N ANKLOG Verna i 00 ROTARY s <br /> �,,,r Art ROTARY_.AUpp cm; OTHER X <br /> e <br /> I NEWESY CORNY THAT 1 HAVE PRDARED TNM APPLICATION AND THAT TTR WOW WILL EE DOME N ACCOIIOANCE Wf1N LAN JOI►OUr1 CO1NAy <br /> RSSULATKONS OF THE LJ1N JOAaM1 COUNTY, NOR;OWW"OR LICENSED AORMS MONATVRE CERM1Es THE VaUffAeft.1 COMFY THAT Mi STATE to Nk AND RULES AND <br /> TIM PMR W M UM=.I SHALL NOT UNWy PERSONS SINJ9CT TO MIOIIIGIAN'i 0011PEIMTWN LAWO OP CALW O V##&. CONrRAeTOES AT IN all PORPO tANCE OF TIN WORK PORWHICH <br /> THE POtLCW m: CE1rW M THE PWIPOM1ANCE OF THE WORK PDR VANCH THIS pWW M NSUWX I STOOLS 0/PLOY POISONS SEI on TOS SIMATU1M CEIITNMC <br /> CALIFORNIA.. MMT NOErIt M ADVANCE POR ALL RtIDEELO AT 4M,4it. COMPEMATION LAWS OP <br /> COMPERE DRAWrNO AT LOWIEI AREA NOVIOED. <br /> SINw X TM. CII or <br /> O.t. <br /> 1. gA11Et OR MADE PLOT PLAN Draw y sm"too*. •y <br /> NEtA D17 TO OR 90ERIO0q TNR PIIOPEIIY. 4. LOCATION OF HOUSE SEWAGE O W04AL SYSMlM OR PtgPOSED <br /> L OUTLrt OPTIR MOPOITV SPAIN OMIEISIONS ANO NORM DIMQTWN. EXPANNpN OF SSWAOE OgPOLAI SYLTEIIS. <br /> ?. OSNENIONMD OVnV"AND LOCATION OF ALL SKMTEIO ANO PVAMe D i. LOCATION WELLS VNIISP RAOILM OF DIRE NtOIOIMD PIRY!T. <br /> Ir1E1C W11-I NCUIDI NO CW40MD ARM SUCH A0'►ATlOk MWNAYS.AND WALIM ON THE O O F VA OR AOMOr1R 0 N OOF ON. <br /> .....:;......i <br /> ....................:.. <br /> ....�.....q... <br /> •..............;......:......n............:......: .. ...... <br /> ..o.....•..... <br /> .:.....:... <br /> Y ,......0......:...... ....:...W <br /> .............y............. <br /> w......�......} <br /> , trt : ....... ;. <br /> l.u.....y11 a...... 4..... �...... .....�....,.... <br /> n i»...:.. ..i......t' a ..i......•...... <br /> .. b.. o.. ti• ..o,.«1 ».i......° 7GJ+..«...a!„ . oma,= �..1�t . ..........i Y <br /> st. .s. q a......:... e......:......o...... <br /> .................Vo..........« <br /> ....... <br /> ....__.. .o. ..bi <br /> ...d.............. <br /> Tl <br /> ....................n...... <br /> .............. <br /> OWARTMpT VSE ONLY <br /> Am <br /> ame IrrP..Ibn sy Pam MrM.d•n <br /> Oru:rden /. <br /> Ela. <br /> C«AMVA* <br /> ACCOUNTING ORLY: AOI PAC/ <br /> PE CODES Pa BOB ARDENT IWWTT® RECMIIM By DATE PEM11rAIMtVICE ItXiIIIIIIIl r1YO1Ot <br />