WORK PLANS - Laserfiche WebLink

Home Browse Search

ENVIRbNMENTALtHEAI~TH DIVISION 304aF-1%ST WESER AVENUE, STOCKTON, CA c 62 (209) 468-3420 IION-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Campklr!n TtigDertr� APPLICATION 19$JERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOWS DESCRIREO.THIS APPLICATION 18 MADE IN COMPLIANCE WITH SAM JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1113.3 AND THE STANDARDS OF SAN.tt?AOUIN COUNTY PUBLIC HEALTH S�E7,FIVICEB,EMVIROHAIENTAL HEALTH DIVISION. JOB ADDRESS/OR APNl L�� C E�`��/y /�PARCEL SIZEJAPNI ] OWNER'S NAM£ (i,C. ADORES ) �7 Lt /'Av�'y' PHONE! �] CONTAACTOR ADORE h� y �i�V� s UCE PHONE a' SUB CONTRACTOR_ /P � ... . ^AODr B % L��L s� UC� LL -'D PI E 1, TYPE OF WELL/PUMP; ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITOR1NO WELL 8 ❑ OTHER 11 INSTALLATION CJ WELL SYSTEM REPAIR ❑ CR.08A-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL.t (TYPE OF PUMPI ❑New❑Rmelr H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL O � - ❑ OUT-oF-SEItvicE WELL ❑ O£OPHYSICAL WELL R 2-- 9, SO1L SORINO ❑DESTRucrroN: INTENOED USE TYPE OF WELL _ CON4TAUC710N tAEC1FICATIONt A ❑ INOUSTMAL ❑OPEN BOTTOM Di A.OF WELL EXCAVATION DIA,OF CONDUCTOR CASING O ❑ DOMESTICMMVATE ❑GRAVEL PACK/SIZE TYPE OF CASING/STEEL/PVC DIA.OF WELL CASING O ❑ PUBLIGIMUNICiPAL ❑DRIVEN DEFT"OF GROUT SEAL SPECIFICATION R ❑ IAMOATIOWAG ©OTHER GROUT SEAL INSTALLED BY GRo1lT BRAND NAME' F ❑ MONITORING l' GROUT SEAL PUMPED:'❑Y". ❑Me CONCRFTE PEDESTAL BY DRILLER:❑Yr ❑Ne S APPROX.OEPYH LOCkINO CHE8TER BOX/9TOVE PIPE 5 PROPOSED CONtTRUCTIONfDWt 1N0 METHOD; MUD ROTARY AIR ROTARY AUGER CABLE OTHER I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND REGULATIONS OF THE SAN JOAO"COUNTY, HOME OWNER OR LICENSED AGENT'S SIGNATUFI�E CERTIFIER THE FOLLOWMO.'I CERTIFY THAT IN THE PERFORMANCE OF THE WoRKC FOR WHICH THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY PERSONS StfflJECT TO WORKMAN't COikAP!FM*ATION LAWS OF CALIFORNIA.- CONTRACTOR-S HIRING OR RUO-CONTRACTWO SIGNATURE CERTIFIES THE FOLLOWING; 'I CERTIFY THAT INTIM PERFORMANCE OF THE WOWS FOR WHICH THIS PERMTr 18 ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO WORIOYIAN'S COMPENSATION LAWS OF CALIFORNIA.' THE APPLICANT FAUST CALL 24 HO IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT 1204144041-4". COMPLETE DRAWING AT LOWER AREA PROVIDED, 1 8tg-w X Tltls_��' PLOT PLAN ID.aw ie Saalel Seale 'to 1. NAMES OF ST S OR ROADS NEAREST TO OR BOUNOFNO THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OLFTLIFIE OF THE PROPERTY,OIV*M DIMENSIONS AND NORTH DIRECTION, EXPANSION OF SWAGE Di8P0 BAL SYSTEMS. .-......ysn HOTLINES AND LOCATION OF ALL EXISTRlQ AND PRGPOBEO t, LOCATION OF WELLS WRIAN RAOIV4 OF ONE HUNDRED FIFTY FT. _-- ••.�,.—vvWAYS.AND WALKS PEATY OR ADJOINIMq PROPERTY. Lz, DEPARTMENT VSE ONLY Det• o �L! Arer / ^ AppSeelien Aeeepled By r - Date O1ou1"Palbn By Ptww InaPeeHen By �. tleNnmelen 1mP-I1e1 BY Dale FAC ACCOUNTING ONLY; AFDir ll LCMEPE CODES FEE INFO AMOUNT REMITTED t ASH R>:CEIVEO BY DATE P91MITISERVICE REQUEST NUMBER INVOICE Pub 4ealth Serv.-EnvirO.173(1197) II .