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OCT 16 1 OST 15 1998 <br /> �- r5 <br /> MARONMENT4 HEALTH ENVIR6NMENTAL HEALTH <br /> PERMIT/SERVICESAPPUCATION FOR WELL/PUMP PETIT/SERVICES <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> XMIIUMAKI PERMIT amm 1 TEAR FROM DATE ISIVED <br /> powkw M Tr4DMM) <br /> APFUCATION M WERE BY MADE TO THE GAN JOAOIIN COUNTY FOR A PERM,TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIED.THIS APPLICATION M MADE IR COMPLIANCE WRTI/DAN <br /> JOAOUN COUNTY DEVELOPMENT TITM CHAPTER S-1116.3 AND THE STANDARDS OF GAN JOAOUIIN COUNTY PUKX HEALSERVICES.ENMARO ENTAL HEALTH <br /> / / '//►/,�J Z�� <br /> IEII RN 7��+� �corcb )7(��. CITY ,fTfD� PAIICEI D12E/AR71 / � <br /> JOS ADDGGIoAP <br /> OWNER'S mum L '�11F gal ADDRESS <br /> cDNTRncTORLxa wwNE /Zf <br /> GLM eolr►RACTOR _sof l.. , AoaEa l.D.&r r/ Qie Ali ucs-l=f,aV—l-ow TY Z+�1V` <br /> TIM OF WRIN M :r NEW WELL REPLACEMENT WELL vffMONITO PRI WELL I MLwS—� O 0THM <br /> INGMLLATION O WELL SYSTEM NormCNOaCONNECT REPAIR O VAPOR EXTRACTION WELL I J <br /> rtvPE of oLNNPI <br /> ❑N.w O n,,* N.P. DEPTH PUFM GET FT. FIST WATER LEVEL O <br /> o <br /> O OUT-OFGERVICE WELL ❑GEOPHYSICAL WELL I Y 901L GORING <br /> O DESTIIlCTIDN <br /> A <br /> O RND mwx O OPEN I1onoM DA.OF WELL EXCAVATION J6-10V-L— DIA.OF CONDUCTOR CAWS O <br /> O DOMESTIGPNVATE90NVLN <br /> GRAVEL PACKAQE�_ TYPE OF CASOMMEEUPVC 61. No DIA.OF WELL CA/RM 0 <br /> O PLNUCAIN twrAL DEPTH OF ORDUT SEAL WVCFICATMN R <br /> O wwavowAo OOTHER own EAL NSTAu.ER GY GROUT SAND NAME i <br /> *MONITORM am"SEAL PMrPED.O Yw ON. CONCRETE PEDESTAL GY DRILLER: w ON. 3 <br /> APROX SG/7N LOXONG't!!!5�VE PIPE 3 <br /> PROPOS COIMTRUCTIONAWA NIG METNDD: MUD ROTARY AM ROTARY AUGER CASTE OTTER <br /> I HF4W CERFW THAT I NAVE PI@APRO TURN AFPUCATION AND THAT THE WORK WILL LE DONE GI ACCORDANCE WITH SAN JOAGUNN COUNTY ORDINANCEG,RATE LAWS.AND RUIES AND <br /> REOIRATONG OF THE SAN JOAOUNI COUNTY. HOME OWNER OR uClNKD AGENT'S MNNATUNE CERTIFEG THE FOLLOWGM:I CERTIFY THAT M THE PERFORMANCE OF TINE WORK FOR WIIICN <br /> TMG MPOW N MMU10.1 SHALL NOT ITYMUOY GIMJECT TO WONWAAWG CONIP MATIDN LAWS OF CALFOISAA.- CONTRACTOR'S HAREM ORI GUFCONTRACTMO SNNATUIE COMM <br /> THE FOLLOWNN: -1 CER W TEAT M THIS OF TW WORK POU WITCH THIN FlIMSRT N MGM,1 SPALL EMPLOY F&WONS SIMJECT TO WSR MOAWS COWENIATMN LAWS OF <br /> C ANT MUST CALL NORMS M ADVANCE PSR ALL REOUMO WWWTIOIM AT UNI4NA4=. COMPLETE DRAWING AT LOWER ATEA PIK VDED. <br /> RIwr/x TRI. o... <br /> PLOT PLAN Drovea go"N.M—'N12Z <br /> I. NAMES OP STRETG OR ROADG NEAREST URAMM ST TO OR GO711E PROPERTY. 4. LOCATION OF/IONISE SEWAGE OINOW SYSTEM OR PRDPOGED j <br /> 2. ou►ua ar THE II OPIRTY.WANOMR0NM A AND MORIN DIRECTION. "PANODR OF MWAN DEPOSAL,SYSTEMS. <br /> �MMMO II <br /> 3.DMOVMRES ARA LOCATION OF ALL EXW MM AIA PROPOSED M. LOCATION OF WELLS WITHIN RAORN OF ONE RRRRDREO FIFTY w. R <br /> STIMriAW MMEUIINiM COVIEW AREAS G N AS PATIOS,ORMWAYS.AND WAIXG. ON THE PIDPERTY OR ADJOMMM PROPERTY. <br /> i. ....>... .....;.. .,. _.._ ....t...... . <br /> .... __.. <br /> IA- <br /> _ .. ...; <br /> .. _ <br /> cc>, R <br /> Ds T USE ONLY <br /> AFFS.MLn A...p W O ON. A:.. <br /> m.0 W+P..M.e by D.t. RS.n►IrrP..Wn GT O.t. <br /> tl..1hw1Nn Mwr..11.n M Dote <br /> Cos"m 1.: <br /> ACCOYNN NO GMT: ADI FACN <br /> R op CoMy" AMOUNT RIMOTTID CISCKNCASN Y YIIIE <br /> DATE PTISRLNCE REOUWT NUIUSMI *#~a <br /> Ds 7 0 22 <br /> Pub HDGMh Swv.-Envko.173(1197) ,;; <br />