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1 <br /> 6. <br /> I <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388,446 N.SAN JOAQUIN ST,STOCKTON,CA 96201388 <br /> {r <br /> (2091468-3420 <br /> Pa- <br /> t T NONREFUNDABLE PERMIT EXPIRES I YEAR FROM BATE ISSUER <br /> w—P P4.R./ ICMNPM AI Tfip&MW <br /> APPLICATION IS HERE By MADE TO THE SAN MADDIN COUNTY FOO A FERMR TO CONSTRUCT ANDNR INSTALL THE WDM[DEY%BEO.THIS ARVCATWN 15 MADE IN COMPLIANCE WITH SAN <br /> JDAQUOl COUNTY OEV RAUENTrTrrI ..-C+XA�PTETfl 91115. MO THE STANDARDS OF BAN J.AONN COLIN PD..0 NEA LTX SERAC'.'FNNPUHMEMAL HEALTH.'NUA. <br /> JOB AppRE66Nfl ARiI I / �P <br /> OWNETS N/JAE 6�,F�� / �L(+�1�Iy Qyl MORE88J NN-19��C��6 <br /> CONTRACTOR Y///✓ �f • /7 1 A L ADd1E58 11CI�70c d p1gNEIy /YZV <br /> rF SIIBCOMRACTOR ADDRESS UCl PHONE 1 <br /> 'P,or WELLRIIMP: ❑NEW WELL ❑REPLACEMENT WELL ❑MOMP O%NO., ❑OTHER <br /> SA ❑INSTAULATpN WELL SYSTEM REPAIR ❑...8 ONNECT REPAIR ❑VAPOR EX1MCTpN WELL I� 1 <br /> C/�//T ❑N—ju RRN" X.P. DEPTH PUMP SET�2A. FIRNT WATER IEYEL Y O <br /> _ RVPE OF RIM% <br /> ❑O UTaFSERVICE.L ❑GE.PNIALAL WELL. ❑ EOIL BOWNG S <br /> ❑DESTRUCTION: <br /> IXTENOEO VSE TTP.OF CONSTRUCTION SPECIFICATION* A <br /> IA. ❑INWSTWAL 13 OPEN BOTTOM DIA.OF WELL FXCAVATWN dA.OF CONp TOR CASNG O <br /> ❑OOMESTICSNU.E ❑GMVEL PA...0 101 CANUMOTEE1/PVC OW.OF.CAN. D <br /> IPAL 11DNON SEDEPTH OF GW VT SEK SPECIFICATION <br /> IIOYGATIOH/AO11E <br /> OT ORDUT ALIF.INMY GROUT ISLAND NAME <br /> ❑MONRONNG /^1 GRCUT.,ALN ❑ <br /> MPEO: Y- OW CO MCREPEPEDESTALIDf....01 G. S <br /> _ APMOx.DEPTH I07 F LOCNRIG CHESTER HNUSD0VE NIF S <br /> PROPOSED CONSTRUCTIONNNWNG METHOD: MUD NOTARY NR STAR' AUGER CABLE OTHER <br /> @BY CURTSY THAT I HAVE PREPARED THIS ANFDCAT DN AND THAT THE WDTK W BE DONE IN ACCORDANCE WRX SAN JOACUIN COUNTY ORDINANCES,STATE LAWS.AND RULES MO <br /> REGULATIONS OF THE SM JDAOVIN CO UNTY.HOME DINNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FL IIG:'I CERTIFY THAT IN THE PERFORMANCE OF THE WO N(FOR W Mll <br /> 6 FEIRMR ISISSUEO.I SHALL NOT EMPLOY PERSONS SUBJECT TO WORWM'S DOMPERBATON I OF CALIFORNIA HIRING CONTRACTOR'S PoG OR BV.ONTPACNNG BWNATURE CC ONES <br /> THE FOLLOWING: -I CERRFY THAT IN THE PERFORMANCE OF THE WOW.FOR WHICH THIS HENAR 18 SMUED.I SHALL EMPLOY PERSONS SUBJECT TO WOIOMM'S COMFEN ANON..DF <br /> CALJFORN/—ycvv/yylrccAMT MEDT CA/Ly/.�XSu/n/ryN ADVANCE FOR ALL REQUIRED <br /> INSPK •AT 13MI MBYU.COMPLETE OMWING AT LOWER MEA ADVISE <br /> BIP�,.ex �ir//_ TIRI. o.0 E <br /> NOT MN W-1.6dW S-1 <br /> 1,NAMES OF STREET.OR ROADS NEAREST TO OR SCUMONO THE PROPERTY. 4, LOCATION OF HOUSE NONAGE DISPoSAL"IN DR REPOSED L <br /> _ 2.OUTLINE DF THE PPOFERTY.GIVING DIMENSIONS AND NORTH DIRECTION. EFPANSOH OF SEWAGE D PUSA-SYSTEM.. <br /> S <br /> VTUNES D LOCATION OF ETISTING AND FW SE <br /> POD HUNDRED RPY FT. <br /> STRVCT..% MNL <br /> INCLVDNG COVERED AREAS SUCH AS PATIOS,DRI MD <br /> O WAS. ON THE PROPERTY DR ADJOINING PROPERTY. <br /> V� <br /> _ <br /> C(J✓&leo-se <br /> _ L sio pe5 <br /> ems° <br /> wEu <br /> SDE <br /> El <br /> E�F r <br /> IL -k, 1 � <br /> DEPABTMEXT USE oNLY <br /> F—.lmPv:Yon r mM 6 I S6 <br /> Dsvucaun Ir.n:Rlnn By DN. <br /> S� COVNTIHO SRI: AID. <br /> pF[ODFb � N� NTRMITTED HVRECSVN SY NRIBPVOE REGUEST NWSER <br /> zz;- <br /> INV E <br /> �`•/1 )U„] O DIC/ <br /> ` F✓ <br />