Laserfiche WebLink
iAXk- <br /> '111111F,1��VV�/y,JJ`1�,,', <br /> APPLICATION FOR <br /> MP PERMIT <br /> SAN JOAQUIIN COUNTY PUBLIC HUEALTH SERVICES Wt..t <br /> WELL <br /> , `J 304 EAST W BER AV NUE STOCKTON, CA 95202 ��! <br /> ENVIRONMENTAL I <br /> " I(II <br /> W � <br /> n (209) 468-3420 <br /> /V Z 7/0 S. „ •- 1110%] E11�0ABlE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> v p!//l (Complete M TrbOFEtF) <br /> AFFLICAMM IS MERE EY MAGE TO THE BAN JOAOUIN COORIY FOR A PEFAIET TO CONSTRUCT ANOgR INSTALL THE WOR(DESCRIBED.TIME AMICATON IB MADE IN COMPLIANCE WITH BAN <br /> JOAMIN COUNTY DEVELOPIEDIEt;TRLE.CHAPTER B•1 t 1 5. ANO THE STANDARDS Of BAN"AMIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DMBION. <br /> /�( JOB AMINESBA APNE " Y - �^ /_� /r •1 ( L �� CT/ PARCEL SIMAPHI <br /> 1�- oMNNER'8 NAME I .�50(nu�5PT ldc 1- L�. / m A J. "� AT101EBB PROW/ <br /> CONTRACTOR Cf L.1 x1121`/ 1 A V L C O r ADDREJ01��1Ox 13 13 UC, PRONE <br /> OUR CONTRACTOR AMAIBSOAJ ktv RST C q - LIc/ PONE, <br /> LYPF OF WEWPUMF. ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL I ❑ OTHER <br /> ❑BJBrALIATGN ❑WELL SYSTEM RE►AIR ❑ CR088-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL/ J <br /> ❑Senone..M H.►. DEPTH PUMP SET—FT. FIRST WATER LEVEL O <br /> "YEE OF PUMP( <br /> XOVr-0FBFRVICE WELL ❑ OEONrvSlc.11 WELL I ❑ BOIL BORING B <br /> ❑DESTRUCTION <br /> INTENDED USE TYPE OF WELL CONSTRUCTION GPECNICAT1ONe A <br /> ❑ INMRTRAL ❑OPEN BOTTOM NA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO D <br /> ❑ DOMEETICTRVATE ❑OMVEL PACKRRE TYPE OF CAIINGMTEEUPW. mA.OF WELL CASINO O <br /> ❑ MBUC/MUMCAAL ❑ORVEN DEPTH OF GROUT BEAL SPECIFICATION R <br /> ❑ IRRIGATION/AQ ❑OTHER GROUT REAL INSTALLED BY GROUT BRAND NAME E <br /> ❑ MONITORING OROUT BFAL PUMPED: ❑Yr [IN. CONCRETE PEDESTAL BY DRILLER:❑Yr ON. S <br /> APP OX.DEPTH LOCKING CHESTER SOX/BTOVE APE 5 <br /> PMOKSHO CONSTRUDEARiNPLIFNO METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE FIEPARED TMS APPVCATIOM AND THAT THE WORK WILL BE DONE IN ACCORDANCE YATII SAM"AMIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND <br /> REGULATIONS OF THE BAN"AMIN COUNTY. NOW OWNER OR 110EN9EO AGENT'S BIUNATUDE CEGNIES THE FOLLOWINO:'1 CITEH Y THAT M THE KRTOR.IANCE Of TINE MONK FOR WHICH <br /> TMS PLRIR IB ISSUED.I SHALL NOT EMPLOY PERSON8 SUBJECT TO WORKMAN'/COMPENSATION LAN'/OF CALIFORNIA.- CONTRACTOR'S WRING OR MU ONTMCTMO IMMATURE CERTIFIES <br /> THE FOLLOWIMB: -1 CERTIFY THAT M THE PEFY-0RMANCF Of THE WORL FOR WNWH THIS PERMIT le R AEG.1 SHALL EMPLOY PERSONS SUBJFCT TO WOADAAM'S COMPENSATION LAWS OF <br /> C AUFORMA' TIMET <br /> ,A( IC 11ANTM!(yJI CALL U MUIU IN ADVANCE FOR ALL AMISH M,SHSRM <br /> IPTNe AT 1.1,.�,tl-iI14SJ8. COMPLETE DRAW W AT LOWER AMA <br /> PIONCDED.nJ <br /> TINE l�.j D•'1-.� f �V`"W\t�' �1 Delel - J / / <br /> ✓J(` Sbr+rl X 7 <br /> PLOT PAN ID,-10 B W.I <br /> 1. NAMES OF STEBI TS OR ROADS NEAREST TO OR BOUNDING THE PIOKITEY. 4. LOCATION OF HOUSE SEWAGE NO OSA(SYSTEM OR PROPOSED <br /> E. OUTLINE OF THE P OPERTY,ONOIU DIMENSIONS AIG NORTH DIRECTION. EXPAMB^N OF SEWAGE DN1M8A-SYeTMe. <br /> S, DIMENMONED OUTLINES ANO LOCATION OF ALL EXISIMO AND PROPOSED S. LOCATION OF WELLS WRHIN IUDGS OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES,IMCLUmHO COVERED ADEAB SUCH AS PATGB.DRIVEWAYS.ANO WALKS. ON THE fromtDY OR ADJOINRG iMRERTY. <br /> cy <br /> A PPkt?X t o tArj V N of Lvc—" <br /> R i N'r P]Fe- N O <br /> / 1 <br /> v <br /> D_ 444UfItZh OFFICE' <br /> rt"G5 OFFICE �UIL�rniL7 Z <br /> J <br /> LAND USE # SA -iq 1� <br /> 1'26 7-f--/ R OAD <br /> JAN 19 2000 I <br /> SAN JOAQUIN COUNT, <br /> PUBLJC HEA _............:.. <br /> DEPARTMENT USE ONLY <br /> AppllanMn AaaT1w1 BY Mr___L�] <br /> Greral lrnpwlbn BY Oe1e Pmp IneOrlen BY DeH <br /> 1)+rr,sllen Irnns'Ibn BY D.II <br /> Cemmre <br /> ACCOUNTING ONLY: AID# FACT <br /> PE CODES FEE IWO AMOUNT REMITIEOCHECXI ASN RECEIVED EY DATE PE6IITREEIVICE REQUEST MUMSIII INVOICE <br /> bP <br />