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— <br /> SAN COUNTYSMP <br /> ENVIRONMENI'q(,PUK4� SER <br /> 304 EAST WEBER AVENUE STOCAMW DMSION <br /> TON, CA 95202 <br /> (209) K <br /> or o eL i 1 <br /> APP.M MM IS H RE BY MADE ro , S TT 1 J R FRAM OA1 IdlpEO <br /> JOAgIBI THE SAN JOAOUIN FOR A PERLLTT TO � � <br /> TRLE �APrEII 5-111lj.3 AND THE tr aA� T'M�SNTALL THE'IDB MIADDNAME APR/ q ^ N wt f OF��oA "KW y P��HEAALTTH TWO It MADE IN COM/pLMNCE"no <br /> SAN <br /> OWNEL•t NAME oC ���' �^ J G o o �'TM `��'oc,� 0,1 ►IEALrH olvapN. <br /> CONT f- I r^ q ` , I PARCEL�2FJAPfII (/4 <br /> SUBCONTRACTOR� /C hF i if . el-iQo ([ ( f A t� <br /> _ PHONE#4 A <br /> D0 <br /> -1�� �1 '-- —�LICs•+LJ��PHONE �Z\`� <br /> of M euro 0 Raw WELL ADORE40 <br /> �-----��� NE <br /> ❑NItTALUTbN O PENT WELL PHO <br /> O Mo"oTown WELL <br /> ❑WELL SYSTEM REPAIR O CROSSCONNECT REPAIR O OTNER <br /> ---------- <br /> TV—"—or PMMP ❑New O RrPeM H.P. DEPTH PUMP SET ❑ VAP011 EXTRACTION WELL <br /> O FSERVICE FT FIRST WATER LEVEL `/ O <br /> TTON P O /�4 wL DOIONO ,s 41/�q ,f,•/a r•�l <br /> r s <br /> 0 tAvrrMAL O OPEN BOTTOM DIA. A <br /> 0 DDMESr fiWVATE ❑ORAyLL PACXJlM TYPE <br /> OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO <br /> TYPE OF CASMq/STEEUPVC � <br /> ❑PUBLICARINICIPAL O 0H1VEN OIA.OF WELL CAB" D <br /> DEPTH OF OADUi SEAL, SPECIFICATION <br /> ❑01 SATKkUAG O OTHER GROUT SEAL INSTALLED BY R <br /> ❑MONITomm GROUT BRAND NAME E <br /> GROUT SEAL PUMPED:❑Vee o RN. CONCRETE PEDESTAL BY DRR LM O Yw O N. s <br /> APIRox.OPTIf <br /> LocKtNo CHESTER soxNlTovE PIPE <br /> PIOPOto COMBTMMTX MUDItLUMG METHOD: MUD ROTARY $ <br /> AIR ROTARY AUGER CABLE OT <br /> HERL 1 NEstY coin"THAT 1 HAVE PRLS'ARED TMS APPLICATION AND THAT THE WOM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUI N COUNTY ORDINANCES,STATE LAWS.AND RULES ANO <br /> REGULATIONS OF THE SAN JOAOUIN COUNTY. NOW OWNER OR LICENSED AGENT'S SMATURE CERTIFIES THE FOLLOVOM:11 CERTIFY THAT SI THE PER FDM4ANCE OF THE WORK POR WHICH <br /> THIN P'MW MMNMD,i MIALL NOT EMPLOY PERSONS SUBJECT TO WOIYGMAM'S COMP0100ATIOM LAWS OF CALIFOMUL- CONTRACTOR'S HIRING 011 SRI6CONTR%CTM SIONATUM CEMTIAEt <br /> THE FO LLLW$Aft '1 CM"rV THAT IN THE FHM�OIM&ANCE OF THE WORK FOR WHICH THIS PERANT N MOM,1 SHALL EMPLOY PES MIS SUBJECT TO WORIMAAM'S CORWISMATMM LAWS OF <br /> CALIFORNIA.' ? W fl'MINT CALL�24 HOURS III ADVANCE FOR ALL ILEO MM TIO AT 12001440-9421. COMPETE DRAWNIG AT LOWER AREA PROVIDED. <br /> SIEnN X_ /i'1✓VVL� D. / <br /> PAT FL.AM Prow M tewo S6ele 'N <br /> I. <br /> NAMES OP SIM I ORMOADS NEMEtT TO OR BOUNDON THE PROPERTY. 4. LOCATION SPHOUSE SEWAGE DMIPOtAL SytTEM OR PROPOSED <br /> 2. OUTLINE OF TIR FIMMITY.MINIM DW*NMOMt AND MM DIRECTION. EXPANSION OF SEWAGE OHSFOSAL Sr*ro". <br /> 1.DIMaNI0IE0 6f/fFNIF.t AND MATSON OF ALL EXMI AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> tTR11CTUlEt,WCLUDRM COMAD AR KAR SACH AS PATIOS,DRIVEWAYS.AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> i <br /> :..... .....5.... .. .. .. . <br /> aC....... ., . s.....P . .............. ..... ......... ......: <br /> ... <br /> _ <br /> ..:.. ..'...'..:. ..'....... <br /> ....................:......•.... <br /> .:......:.. ...... �.......:......:..... .. .. .. .. .. .. .. <br /> ' - - <br /> ' .. <br /> • .. <br /> INAOQART uSE OILY <br /> AVPketlen Amwted By IF bete /[ AMe. <br />