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' APPLICATION 10 HOPE BY MADE TO THE SAN JOACUM COUNTY FOR A PERMIT To CONSTRUCT AND/OR MSALL THE WOW DESCRIBES.MR APPLICATION IB MADE IN COMPLIANCE WITH SAN <br /> "AM'"CVt DEVELOPMENT TALE,CHAPTER <br /> �9-11115.3 AND THE STANDARDS OF BAN JOAMIN COUNTY PUBLIC HFTTH BEIMCEB,TNWMNMwm HEAVN OLVISTon. <br /> JOB ADDREG&JR APNF /V0 <br /> t /I�,/ t , �, $�„ �,_, /�Y/S �T •CTTY W/t iclo& , PARCEL�RM�N,ARF <br /> ONMI'l HAM I A93 4%,00 l HNE_,I -/757 <br /> CONTRACTOR N/ JR p <br /> OF <br /> PHONE1 93(-32ty�� <br /> •Iro CONTRACiORL!` CL� OREEI,_, .Sa ([ IpNEF �.}G <br /> ' TYFEOFWEUJPUMP ❑NM'WELL ❑ REPLACEMENT WELL ❑ MONROWNS WELLf ❑OTHER <br /> ❑ INSTALLATION WFtj.VStESI REPAIA ❑ CM98-CONNECT REPAIR j ❑ VAPOR EXTRACTION WELL.9 J <br /> N.P. 7,S DERHPUMP SET� . PWRW WATER LEVEL <br /> RYPE OF FUMR _ L <br /> LOUT-0FDEtNICE WELL ❑ OEOPHY6ICAL WELL f ❑ SOIL BORNO 6.1 <br /> INTENDED ME T W CONSTAOCUOM SPECIFICATION A <br /> L MOVOMAL ❑OPEN BOTTOM DIA_OF WELL EXCAVATION VIA.OFCONDYCTORCAMNO 0 <br /> LIIOAFFAle VATE ❑OPAVM PACXI&VE TYPE OF CASWOOBTEEIRVC DIA.OF WELL CAROM D <br /> �L PPRUCOMUNLCIPAL ❑DRIVEN DEPTH OF GROUT MAL BTECOCATION R <br /> ' pMRIOAMNIAO ❑OTNER GROUT SEAL INSTALLED BY T9 OPOW BMNO NAME <br /> MOg <br /> NNORNO ORDVL SEAL PUMPED;❑ ❑ <br /> Ya HP CONCNETF PEDESTAL BY DRIMM 13 Ya ❑Pro s <br /> APPROX.MPTH LOCRINO CHESTER BOXIMOVE PBE b <br /> F OMM COMORUCl1ONXMRUNB METHOD: MUD RDtARY AIR RDTARY AITOIE _CABLE OTHER <br /> ' I REVEY CERTIFY THAT I(PAYE PREPARED THIS APPLICATOR AND THAT THE WOR(WIU.BE DONE M ACCORDANCE VNIH SAN JDADIAN COUNTY ORMNANCM,STATE MWD,ANO RULES AND <br /> PWO1MTIONS OF THE BAN MAOIRN COUMY. HOME OWNER OR UCENGED ADEM'B DISNATVRE CERTIFIED THE FOUIPAINS:T CERTIFY THAT IN THE PERTORMANCF OF THE WORE POLI WHICH <br /> TMS PFRMR MMBIEO.IfIALL NOTEA1ROr PEMIOND SUBJECT TO W011OAAN'I COMPpiAUON MWM OF OAlIFO1PWA' CONTMCTOR'I MIYHO OR811&CONIMCTMO BONANPE CEORRlF <br /> THE TOI.LOWMB: 1 C M THE ANCE OF THE wow FOR WHICH THIS PERMIT R IBMEp.1 ISLAM EMPLOYy PERSONS SUBIECT TO YIORFMAWM OOLTPENBATON LAVYe OF <br /> CAMOMM.' I.a H "MADVANCE"A ALL RMHIMED t WNPM'NOWAT MCD)/Al84114".�COMRXTEOMWNIO AT LOWER AREA PROVO <br /> TlOD_ yy�.i�i�-C '/CSVA'Ct Dm <br /> NFPFi X <br /> PLOL MR RAP.[s Ba�lp DPFIF tP� <br /> ' 2. NAMES OF eTHEETE OR MAINE NEAREST TO OR BOND NOR TNF PIMIER. A. LOCATOR OF HTDUHE SEWAGE AL I OPAL SYSTEM OR PROPOSES <br /> 2. CVIDIWINSI N THE PROPERTY.AN LOCARRHO DIMION OF AM AND NOON DIPIEMION. EXPANBON OF BELLS W VftN m.FY FON <br /> ]. OINFNDIONFp OOT ORIG AND EKED AMA OF ALL E S PAT AND RAPOBED 1. LOCATOR OF VIFUW NATION RADNB OF ONE HUNDRED FIFTY FT. P, <br /> DTRUCIUIIEB,INCLUONO COVERED APEAB EVCN AS PATIOS,ORVEYYAYB.AND WAIR0. ON TML FROPFRIYOR ApJ01NIN0lAbPERT'T. <br /> .r..... .i... .I.. 5....;. .P. .... ..i ... <. <br /> : <br /> .... <br /> ; <br /> �.. .T <br /> :.... i. .i .'; .;...... .. <br /> . <br /> s. <br /> .N• <br /> hs <br /> AR <br /> .: i . :.....i. . . <br /> z .. . f <br /> ._:......:.. <br /> ., .. s. . ..:.. <br /> e. <br /> ; <br /> •T: <br /> .T.... t ' r9mJ.1:,?•fie f 'NDa,S <br /> 1 : :rt,,inglA4T . <br /> t <br /> ' DEPARTMENT U•E MLY <br /> APNbFLroA ATAgWI EY DE4 AI <br /> 'fz,�1olt D DS� <br /> O-w BnPFPIroR EY DFM F1FtIP IngrPellen BY _ tel: OMP 6 <br /> ' Dauncllan NSPWIFn TlY_ /� + „ mt._ <br /> Canmw,b: S T Q6 /''fir i41C4 i4t4-4_ .:e f1-fA Ae . Arfive- - w •�,- (.. �evP..F{ (s',(�/„Arot/ri:" G /f <br /> ,o..:+A_ 1 we[(..e Le„� L•sed a�-»•t ,s teA� af[ WaldcA cater —7� i <br /> ' PCCOLMTINO ONIV; Alpf FACE <br /> FECODFA PEF BHV AMOUNT RB.WT950 RMN IEODVED IY DAVE PHWAITpDIVICF REGIIFIT NUMBDL iNwNE <br />