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APPLICATION FOR INUMNIP PEANUT <br /> SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION - <br /> P.O.BOA(SBH,504 EAST WENR AVEC,STOCKMK CA 95201 <br /> (2111 4BN3420 <br /> ■- OUPARLE"OMIT[MKS I MR FIEN DATE 1"IN <br /> {IYmplw 1a TTIp11eitPE <br /> APPLICATION iS HERE SY MADE TO THE SAN JOApWN COUNTY FOR A PERMIT TO CONSTRUCT AwioR INSTALL THE wom DEB ram.TFSS AmIcATRR.IS MAIN IN COMPIANCE YIRTTI <br /> JOADWN CDLWTY DEYHCPMENIr TITLE.CHAPTER S-11 115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH VEAVICEB,ET/V PM&U ITAL HEALTH WASION. <br /> JOB ADDIffilmm APNP 27337 S. BANTA R D. an• TRACY PARCEL iA=EIARy1s <br /> Oman NAME HAL ROB RTSON A,,,,. 27337 S. BANTA RD. TRACYRI , 832-88 <br /> CONTRACTOR HENNINGS BROS. DRILLING CO. ,INCA6oR�Bs3525 PELANDALE MOD . 90813 �E,f545-14 <br /> wIBCONTITACT011 ADDRESS 1lCs PHO11Es <br /> TneoFxrEIC/W M 17 NEwwnL R[AJICEWNf VWLL ©Mowomm WELL 13 OTHER <br /> 0 INSTALLATION ©WELL SYSTEM#PMA ❑CRUESCONNECT REPAIR ❑VAPOR ERTRA1.MN WELL I <br /> O Rom I]RM14 N P. OEM SUMP SE7 FT. RRST W A M IEVR .;x: <br /> am OF PUMP) ::. -'i5'. <br /> OW4)FSERME WELL 0 Dee*YSK:AL VML i 13 Moa so mm ,y s <br /> WFIZEO U" <br /> ©bESTM1L'TIGH' - <br /> 1�RRDUSf1IAL OPEN BOTTOM DIA,of HELL EILCAVATKIN� 12" OUR.OF CONO4=CR cA81NOL <br /> UbOMESTRCAISVATE ®GRAM PA0U8IZ TYPE OP CASW(USTEEIA+VC� 611E of WELL CASSIS,,,,• {7'I - <br /> 0 PI SWRA A CWAL CIOFFWEN �00"OFOROUT�AL�,y�� �ZJ.S' FIUTION B E NT Q N I T E - <br /> ❑PWIoATIDNIAO ❑OTISM wwuT SEAL INBTAuED Iv W F N N T N ti INISIPT www NAME A; <br /> ❑MONITORING GROUT SEAL PUNNED:Z7Y.P 17 N. CoNCIm FEDEsTAL BY mum❑Y.. N. <br /> JIPSgK.DEPTH 7�✓ LnrJLBIn CHESTER BOx16TOVE PWE <br /> PDBPOBED CONSTI ucrA NIBIIum METHOD:MUO ROTARY- x x - -MR RaTAK AUGER CABLE OTIC.--.....` kk... <br /> 1 HEMESY CERTIFY THAT 1 HAVE PREPARED THIS APP ICAMN ARID THAT THE WORSE WILLIE DONE IN ACCOROANCE WITH SAN JOAOUNI COUNTYOFDI/MNCES,STATE LAWS.ANO <br /> RROIRATKMO OF THE SAN JOAOISN COUNTY.HOSN:CW WA oR LICENSED AaWT•O SIO MTLH%t CENTINIs THE POUDVAW.7 CERTIFY THAT INTHE PERFORMANCE OF THE VAW FOR. <br /> THIS PERMIT M I0/11ED.I SHALL NOT EMPLOY PERSON!SUBJECT TO WORXMIIN'S COMFGISATRIR LAWS OF CAlA�Is/S1L.'4VNTRACTOR's Htl1810 OR SUB'COIJTRAC781G SJSNATW!-. <br /> THE FOLLOVANO: 'I CERTIFY THAT IN THE PERFORMANCE OF THE VWM FOR VMCH THIS PERMIT 0ISIM,1 MALL 9ARIIY PERWAIS SUBJECT TO WapW ANN COEIP'OISATION1%Gi1B. i <br /> CAIiHMSDA.' THE AP IWGANT MUST CALL 24 MOUND 0 ADVANCE POR ALL REOIII ED HMSI M AT Il/SI dill.COMlPSTE ORAWM AT LIOWER ARIA PPIWWWED. <br /> C.,. 11-22-95" <br /> �F <br /> PLOT RAN W'_ft <br /> S-W a.O. <br /> 1.NAMES OF STREETS OR ROADS NEAREST TO OR SOUNOM THE PFOPORY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM CK <br /> 1.OWUW OF THE PROPERTY.WANG DIMENSIONS ANO NORTH DIN!CTFON. EXPANSION OF SEWAGE DWOSAL SYSTEMS. <br /> S.OIMENSNDNEO OUTLINES AM LOCATION OF ALL FJuBfM AND PROPOSED s.LOCATION OF WFLLs 1MST1s11 AADRIS OF ONE HUNDRED FFT1171r` <br /> STRI CTIRIE%R CLUDSM COVEMD AREAS SUM AS PATNM,DRIVEWAYS,AND WALKS. ON THE FNOPERI•Y OR ADJORIRIO F71oPERTY. -:•�? <br /> 4... _. d.-.,. - . .. <br /> \J <br /> a <br /> ia <br /> a <br /> II. <br /> I , <br /> 3ik <br /> -... <br /> X011 �:7 199 .. <br /> rs..: SI:..,.. .... <br /> V - <br /> . i75V1 <br /> r -�--- DVANYMIM USE ONLY • :¢y <br /> Appft.d-A-.PtW GF �4 DK. Z Aw <br /> Ce.MRMwMIr. <br /> J[CCOtNf7TIPS OIHYI AID# FACP <br /> R Com F8 U" AMOIMT REMITTED MII RECEIVER SY DATE V910"fe"W it ABWJDT NWMSEI "Woo +I. <br />