Laserfiche WebLink
I—Fmpmw <br /> rml <br /> APPLICATIONIS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PEFMIT TO CONSTRUCT AND/OR <br /> JOAQUlN COUNTY DEVELOPMENT TITLE,CHAPTER 9.11, INSTALL THE WORK r- 'BRIBED.THIS APPLICATION IS�E WITH SAN <br /> 3 ANp THE STANDARDS OF SAN JOAQUIN COUNTY RJBUC HEAD' <br /> JOB ADDREssroR aPN� L <br /> �L J y ; f� S�� VICE8,ENVIRONMENTAL HEAL <br /> CITY PARCEL SkMAPN# - <br /> OWNER'S NAME ADORES6 L S. <br /> CONTRACTO �1�5/�-//d/�- <br /> PHONE 1 <br /> R ADDRESS lO�7 f�(J�/� Gpf ��/,��F��7 PHONE F•.J�Z�F <br /> BUB CONTRACTOR ti�LU" /(!� ADDRESS ��� ,a,"_ L. .. <br /> PHONE I• —dZ- <br /> TYPE OF WELLIRIMP: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORINTi WELL I ❑ OTHER <br /> © INSTALLATION ❑WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL <br /> Q Now❑Repair H.A. DEPTH PUMP SET J <br /> ITYPE OF PUMPI _Fr. FIRST WATER LEVEL_ O <br /> ❑ ouT-0E-SERVICE WELL 13 GEOPHYSICAL WELL i ® SOIL BORING <br />' ❑DESTRUCTION: <br /> WENDED U8E TYPE OF WE7.1 CONSTRUCTION SPEClPooeeeeo <br /> CATION8 <br /> ❑ INDUSTRIAL ❑OPEN BOTTOM DIA,OF WELL EXCAVATION----,L e!3J A. <br /> _ dA.OF CONDUCTOR CASINO D <br /> ❑ DOMEBTICIPRIVATE ©GRAVEL PACKlSIZE TYPE OF CASINGlS'rEELA'VC <br /> ❑ PUBLICIMUNICIPAL ❑DRIVEN DIA,OF WELL,CASING�� D <br /> IRFUGATIODEPTH OF GRt?UT SEAL SPECIFICATION `T <br /> ❑MONITORING D OTHER (;ROUT SEAL INSTALLED BY r rj~ S <br /> GROUT BRAND NAME <br /> MONITORING E <br /> GROUr SEAL PUMPED: ❑Yw No CONCRETE PEDESTAL BY DRILLER:❑Yee ❑No S <br /> APPROX.DEPTH LOCKING CHESTER BOXISTOVE RPE <br /> ROTARY <br /> PtOPObm CONBTRUCTIONBigIWAIR NO METHOD: MUD ROTARY — S S <br /> AUGER CABLELEOTHER /'II <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WrrH SAN JOAQUIN COUNTY ORpINANCES.STATE LAWS,AND RULER AND <br /> REGULATIONS OF THE SAN JOAGUIALL NOT <br /> COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT N ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SULICONTItACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: 'I CERTIFY THAT IN THE PERfO E Of THE WORK FOR WHICH THIS PERMIT 18 ISSUED.I SHALL EMPLOY PERSONS HIRING <br /> GT F' WORIOHAN'b INQ SIGNATURE LAWS OF <br /> CALIFO T CALL 24 NO IN ADVANCE FOR ALL REGUlA TION&AT 1208)4SIMALL E3. COMPLETE ONSDRASUB AT LOWER AREA M S CO FD. <br /> squad x �"'7 <br /> nda "7 <br /> I. NAMES OF STREETS OR ROADS NEAREST TO <br /> SO. <br /> THE NPROPER TY MIro�to Be"BoNa is <br /> 2. OUTLINE OF THE PWPERTY.GIVING DIMENSIONS AND NORTH OIRECTKHN. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> STRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> ON THE PROPERTY OR ADJOINING PROPERTY. <br /> . _ .... _ <br /> .. - - .. - <br /> HEALTH S�Rvic;"i'7 <br /> -_ <br /> DEPARTMENT USE ONLY <br /> Application Aeeaptad By <br /> Great Irtepeetlan BY <br /> Dete-14—LA) Arae`-''"�••/+ °' <br /> Dow Pip Impaction BY . <br /> Destruction Ineeectlan By - Dela <br /> ra <br /> Comment[: ---Zeta . <br /> it <br /> ACCOUNTING ONLY: AID# <br /> FACT <br /> PE CODES FEE INFO AMOUNT FdMlrr / •` <br /> .`HEC !CASH RECEIVED BY GATE . <br /> U PERMIT186MCE REQUEBT NUMBER <br /> INVOICE <br /> 00 6 <br /> .iu9 <br /> SAN' <br /> 4 <br />