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{ � 1 <br /> c <br /> r <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 45202 <br />[ (209)468-3420 <br /> FOR RtFURGAI_LEPERINIT UFFIES f YEAR FROM DATE 13SUED <br /> X"wilsn fm TRIp9eetM1 <br /> APPLICATION la HERE BY MADE TO THE SAN JOAOUIN COIRTY FOR A PEMAT TO CONSTRUCT AMMON.NSIALL TNF Wom DEFc MNEO TIRE APPLICATION 16 MADE M COMPLIANCE WTI.MAN <br /> JOAOOM COUNTY OEVELOPMEHf irryLLl CHAl'rvm 9 1 119 3AND THE Er#mArdm or BAN JOAOMIN CouN11�TYRE♦L1CHEALTH eERVICEM ENVIROMAENfAL HEAtTN OME1oN <br /> 1 <br /> JOB AOMsamn Arm I l� `V•V t&+ E,r 6L _M.IL PwA CNY Si.,+A�o^ PAlI�C1tL MF�FIAPN/ <br /> OWNERS HAMS cWe.S L <br /> CONTRACTOR FS`l � - _ 1 . _ •^—AOOISS Iq9WWON�� - PNOFE s <br /> AOORFaSCr9t`p ._ k� _ ka RMNE L,p 5w,-aa <br /> SUB CONTRACTORSG*j\ D ..3"5■TL-"&ila-+V%L <br /> FHVNE.�4}iZ- <br /> TYPE OF WRLmm, ❑NEW WELL ❑F&AACDAU"WELL 13 MoNTORMO WELL r ❑OTHER <br /> CI MRALLATNON ❑WELL e1YTE1A REPAIR ❑evowCowact-REPAIR ❑VAPOR I!XFRACTION WELL I .T <br /> RYPE OF PLNMPI N► DEPTH PUMP aMT�Pr FIRST WATER LEVEL 0 13OVfAP-SFIIVICM vvEtL ❑GEOPHYSICAL WFLLr soksom O Q1Oo1i- iO a <br /> 13IMSTMXTPDW <br /> MST O CO S1RUC SPECOIC `�,1 A <br /> ❑mHoomMAL ❑OPEN BOTTOM DIA.OF WELL EKCAVATIOH RMA OF CONDUCTOR CAMMO ./1V O <br /> Q DOMESIVA"VATE ❑ORAVEL PACKMRE TYPE OF CAaREGn1EElJPVC LMA OF WELL CARING IV D <br /> ❑PLIbL.ICAMONICiPAt ❑ N OEPIH Of GROUT SEAL S SPECIFICATION AA <br /> ',. -`__ A <br /> �❑RSSGATIONIAO aTNE11 OACWT EEµMSTAU BY OMUT ERAND NAME I L £ <br /> RI MONNITISNO _ emn SEAL mmmo ❑Y- !M CONCRETE PEDESTAL BY DIELLER,❑Yw 014. S <br /> APMON OWfH }T=F"�- LOC"m CHER[R W><ISTOVE PNE <br /> MIOPOSED CONSTMMINNIM RM MOI <br /> IrtETNOO MUD MOTAPIY AROTARY AVOER CAME GTHER-_F Oi fGd-►ZLk <br /> I NEIWBV CTRTFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THII WORK.WILL BF DONE N ACCORDANCE WFIH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS AND PRIES AND <br /> REOUTATIONS OF TINE SAN JOAOVIN COUNTY HOME OWNIR CR LICLHRD AGFM a SMNATVIE CERFIFIEE THE FOLLOWMO 1 CERTIFY THAT M THE PERFORMANCE or THE WORK TOR WIECH <br /> TMS PEMAT IN ISMLIFo 1 PIALL NOT DAKOY REASONS SUBJECT TO WORKMAN S COMMOATIDN LAWN CWCALWOMA. CONTRACTOR I RARING ORSU"ONTRACTR I ONGNATURE CeFITOIES <br /> THF FOLLOWINO 1 CtRTWY THAT IN TRE PERFORMANCE OF THE WOML FOR VWICH TMS PERMIT IS ISSUFO 1 SHALL EINPL.OY PERSONS SUBJECT TO WORKMAN 5 COMEOIMATION LAWS OF <br /> CALIFORNIA The AHJCAM MVsT eM S•FOUNS N AUVAPCS/M ALL PgGtW 6 WWW"0100 AT 12011 409-04" COMPLETE ORAYONO AT LGWFR AEA FROVOEO <br /> MIP-d R TM. O.I. <br /> PLOT PLM M—w Sa lel <br /> 1NAMES OF STREET.OR ROADS NEAEST TO OR BOW413*00 TTM pOPE11f1/ a LOCATION OF HOUSE IWWAOE INN40 L SYSTEM ON PIOFOSEO <br /> 2 OVTONF OF TNM PROPERTY OMMO OmUmeloNe A v NORIA DSECTKM EXPANSION OF SEWAGE pWOSAL 6 MFMS <br /> O bRAEHMONFO OVTLOLFe AND LOCATION OF ALL EXISTING ANO/ROPOSEO I LOCATION OF VAUN WR1nN IUOIIFs OF am MRIDPED FETY FT <br /> /CT <br /> eTPRMIL MCLUDBIO COVEFEO REAS SUCH AN PATIOS.ORBVEWAYS.AND WALKS I ON 1114 PIO/ERTY ON AUJORNMD P Of4MY <br /> DOCK <br /> /- <br /> 4 <br /> NSOLINLM[$ <br /> N <br /> �O <br /> • CORP <br /> M[IAL YWE <br /> ` 4 SOB2 ELDG <br /> NW.R MWl J/ <br /> • <br /> S25 <br /> YWy <br /> 1 <br /> CCf/ <br /> RLSTA AKI <br /> NWY4 <br /> NNS <br /> I <br /> PROPANE[] <br /> TANK <br /> O <br /> ILGENIH <br /> • ..Ha.L...ti.o.w SITE PLAN <br /> 0 Frnnxa LOA.a..N KING ISLAND RESORT <br /> 4 11530 WEST EIGHT MILE ROAD <br /> wFu STOCKTON CALIFORNIA <br /> e A....eKF.No.rraA.I..eu <br /> PRFPMED Ld1 <br /> 4 .NAarewOL WESTREC MARINAS <br /> we � <br /> N. PAIL ewe/ALYIBON y a 5e T[LF FII`LIAF 7 "iwYMA i <br /> OWAITMMT Ust ONLY <br /> AMI..O.n A.•MI.4 BY D•I• M.• <br /> o.—i w..wn.n B1 O.I. P-*h.0—NN BY 0.1. <br /> Owlni.Il.n M•I..I1.n eY Ow <br /> C.mmarM. <br /> COIINTRLO ONLY AID. FAC/ <br /> PE CGOEM TLE INTO AMOUNT REABTTW CHECFJICASN RtCRVN BY DATI PONSMITMRLVRCE 199UUMT NUMBER INVOICE <br /> Pub Heats Sery Envlro 173(1187) <br />