Laserfiche WebLink
APPLICATION FOR WEWPUMP PERMIT <br /> SAN JOA0IIIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> i _}*.O.BOX 588.304 EAST MINM AVENUE.STOCKTON.CA 85201-M <br /> tP1191 4883420 <br /> nWlj!Ulb49Ll PIM 9EMM 4 YEAH FNUN[DATE ISGUEO <br /> APPUCATW M 16 HERE BY MME TO THE BMT JOAQUIN COUNTY FOR A Peffiff TO CONSTRUCT ANDIOR INSTALL THE WORK DESCPFSEO.TM AFPLX:ATION RI MADE RT COMB ANCE HErH$AN <br /> JOAQUIN COUNTY DEVELOPMENT TrrM CHAPMk 1118.3 ANO E STANDARDB OF BAN JOAQUIN COUNTY P I=HEALTH BERVICEB.ENVpBPMEJNTAL HEALTH DtM INOM <br /> JOB ADDIKS u �. Cp'Y PARCEL BIZFJAPNS_ <br /> tlMiflfA'B NAME ADDRESS PHONE S <br /> CpRFTRAC7 ATR1RE61 �,PWNE <br /> SUB CONTMCT4R � AOORESB LICE �'� 17lONE E <br /> �1 WVFEWPUMP. 0 NEW WELL ❑AEPLACEum wELL ❑NBONIFOIONGmiA ❑OTHER <br /> ❑INSTALLATION ❑vueLL REPAIR ❑enoBstoN AM 13 VAPOR ExTRAcTATN vmLf J <br /> ❑NRw©iMPMR NY. DEPTH WRAP BEWT ARB!WATER LEVEL ,T O <br /> OF <br /> ©OUT-OF-SKIVICE WEIJ. ❑OEOAIYSICAL WEIRS ❑ BOIL soma e <br /> ❑OESTRUCTIDN: <br /> Wi <br /> ❑�T�III}NDUSTRIAL C}OPEN BOTTOM GIA.OF WELL CXCAVATNIN DIA.OF CONOUCTOR CASINO 4_3 <br /> tiL OOMESTIGP IVATf ❑GRAVEL PACK-@M TYPE Of CASINGMTEILPM SHA-OR WELLCABINR O <br /> //❑FUBIMAWIMAPAL ©DRIVEN DEPTH OF GROVE SEAL SAEGRCATION k^ <br /> ❑IRRIOATRONUAG ❑OTHER GROW SCAT.MSTAUfO BY GROUT BRAND NAME E <br /> I7 MONITOADXN oROUT SEAL PIIBRP m❑vw ❑N. CONCRETE PEDESTAL BY m Lt m❑Yw ON. <br /> AWROX.DWFN LOCKING CNESTER SOXWOVE PIP4 <br /> PROPOSED CONSTRUCTIMU MLUND MITHOD.MUDRDTARY AIR BOTANY AUGER CABLE OTHER <br /> C <br /> I NMEY CMTry THAT 1 HAVE PREPARED T1410RK IB APPUCATION AND THAT THE WOWILL BE DONE IN ACCORDANCE VOTH BAN JDAOUIN COUNTY ORDINANCES.STATE LAWS,AND RUREB AND <br /> REGULATIONS Of THE SAN JOAOUIN COUNTY.HOME OWNER OA 17CBNBm AOENT'B MHATURE CERTIMS THE FOLLOWING:'I CERTrtY THAT IN THE PERFORMANCE OF THE 4AIM FOR <br /> THIS PEW,IS ISSUED.I SHALL NOT EMPLOY PERSONS SUBJECT TO WOR IC114"S COMPENSATHIN LAWS OF CALIFORNIA.'CONTIIACTOWNHIRING OR SUBCONTRACTING SIGNATURE CEITTIFIEW <br /> THE FOUDVVINGGv'I CMIFY�T/HA�T M TSB PERPDTMIWCE OF THE WOW FOR YADCH TMS PUMIT IB HIBUED.I*HALL ENIPLAY PERSONS 1 JWWT TO WOMMAN'S COMPENSATION LAWS Of <br /> S�SIHFORNLOE .•4 1'WT If JY �RI AWANCB PINI/llt REWNIW IIggR1TGN/AT 1aD/1' OMNMiB AT-LONRR A�/1FA PRIOMO[O- <br /> --11�� PLOT RAR ID.Rw w awo a.M.�JdK�/j JjJT-1L'lfb(y �. <br /> T.NAMEB OF STFMD ORI ROADS NLAMET TD OR BOUNDING THE PLOFERITY. A.LOCATION OF HOUSE BEWME DISPOSAL SYSTEM ON PROPOSED <br /> R.OUTLINE OF THE PIIDFERIV.GIVING DIMEMEDM AMD WWfH COMMON. WANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3.OMENSIOMED OUlUNM AND LOCATION OF ALL EXRSTINI AND PROPOSED i.LOCATION OF WELLS VNTHOI RAOM OF ONE MINDRED FIFTY FT. <br /> STR11eTURE/.RNCLWINO COVERED ARE"SUCH AS MTRW DRIVEWAYS.AND WAIXS, ON THE PROPERTY OR MJOIND0 PROPERTY. <br /> ..,._ °. <br /> W <br /> - PIkYMMT <br /> .. <br /> RECEIVED <br /> iM.09 <br /> SAN J6.,JUIN�, UNYY: . <br /> [PUBLIC HtR6,fFI�SHVIf Ei <br /> ENYIRONlr1£1 ffAC-HM TMl'DIVISION <br /> S <br /> DWARTMER OB!ONLY <br /> AppBwlbn Awgbd BY DE1e ���'""/' <br /> a.elR hIgFP11pH OT OM. Pu++a R+z,r.Nan Rr � — DAtS��L a 99 1� ; <br /> orHueRl.n IRRPAEIIES By <br /> Cwm+Iwkr. <br /> -ACC DUN-TWO-ONLW. ASW fAC1 <br /> }[CODES FEE INFO AMOUNT REMITTED C ASN REOVVCO iY DATE PEErMT)AGWICB REONEST NNWEI INVOICE <br /> RAZ <br />