SU0000026 - Laserfiche WebLink

Home Browse Search

i APPLIC�1 TT.10h _. ..-LiwUMP PERMIT SAN JOAO, UNTY PUBLIC HEALTH SERVICES ENVI..-MENTAL HEALTH DIVISION PRO,BOX 388,3"EAST WEBER AVENUE,STOCKTON,CA 95201388 091408-3420 I , NON-REFUNDABEE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED {Cempl{t{In TOPIWAIG) APPLICATION IS HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED.TI118 APPLICATION 18 MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9-1115.3 AND THE STANDA RDS OF SAN JOAOUIH COU]�NTy PUBLIC /HEALTH ?SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB AVbREB81OR APN# e9V �7 sr In, �/� J ill R.Y1 � CITY //i C�/, L�'7 i7 J �6 PARCEL SIZEIAPN/ OWNER'S NAME ��,T xha." SRH 4:}A�N` AopRE58 � � C ONE E r� ADORES 6✓J~7/�/ CONTRACTOR Sf PN/X 02 . l-afcP ADORESray -r �IJ�GIG��'l,_,S PHDNEr�f3�—�//fit SUB CONTRACTOR ADORE"- ADORE"- rV`/ a•�•y j� uC/ PHONE i TYPE OF WELUPUMP' ❑NEW WELL ❑REPLACEMENT WELL ❑ MONITORING WELL r ❑OTHER f 11 INSTALLATION 11 WELL SYSTEM REPAIR ❑CRO88-CONNECT REPAIR ❑VAPOR EXTRACTION WELL I J LC Y 13Nwv epalr HA./ DEPTH PIMP SET�LFT. FIRST WATER LEVEL-62=7 O (TYPE OF RIMPI � ❑OUT-0P-SERVICE WELL ❑GEOPHYSICAL WELL r ❑ BOIL BORING B ❑DESTRUCTION: ,r v [NTFHOEO USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A ❑INDUSTRIAL 13 OPEN BOTTOM VIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASING O� ❑DOMESTICIRBVATE 11(;RAVEL PACKISIZE TYPE OF CASINGMTEEUPVC DM.OF WELL CASINO ❑PUBLICIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL SPECIFICATION A-.-I ❑IRRIGATIONIAG ❑OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME E r^ ❑MONITORING GROUT SEAL PUMPED:❑Ys [IN. CONCRETE PEDESTAL BY DRILLER:❑Yw 110. S t's APPROX.DEPTH LOCKING CHESTER BO%IBTOVE RPE S PROPOSED CON{TRUCTIONIDRILUNO METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER S' I HEREBY CERTIFY THAT I HAVE PREPARtb THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES ANp REGULATIONS OF THE BAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF TRE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN{COMPENNATION LAWS OF CAUFORNIA,•CONTRACTOR'S 141RINO OR SVSLONTRACTINO SIGNATURE CERTIFIES THE FDIL NO. -1 C REIFY THAT IN THE PERFORMANCE OF THE WORKTOR WHICH THIS PERMIT IS IBSVE0.4 SHALL EMPLOY PERSONS BUBJECT TO-WORKMAN'{COMPENSATION LAWS Ol� CAHFORNIA.- TNF CANE MV{i CALL 74110 VR{IN ADVANCE FOR ALL REQUIRED INE/P�FQCTO�N�S AT(201H 402147E,COMPLETE pRA1Y1NO AT LOWER AREA p{Hp VIDE SSPrwd% �s �� TIII._... IJ{ PLOT PLAN(Drew to 8—W 9-1. 'to 1,NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOBED T.OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. E%PAN$ION OF SEWAGE DISPOSAL SYSTEMS. 0,DIMFNBIOMED OUTUNES AND LOCATION OF ALL EXISTING AND PROPOSED E. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWA YS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. s1, n... o� s .. : , : .. € . .... PAY W1ENT sTr : a 6 '6'-1: iss P . . AU �11997 ... ? SAN dCAOUiN COUNTY - . .. .....,,,; - :��. .� .�-. . . .._ --P11B1_iC1HEALTH SERViCES--' -. -:....`-. .. ....<,. ..... .... , ' ENVlHUNNENTALHEALTH C)1V Sb DEPARTMENT USE ONLY Appli—teen Amepted ByDita Arer r Grein Impaellen By Opla Puny Impeellon BY "�� [� pple -'I `� 7 l ' Deat—tlan Impeetlen BY Det. Cemmener. ACCOUNTING ONLY: AIDE FACT PE CODES FEE INTO AMOUNT REMITTED C.ECK fikA.. RECEIVED BY DATE PERMITI{EIMCE REOUEET NUMB6H INVOICE 10 8 5