Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> RAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMVML NIIALTN DIVISION <br /> P.O. BOX 988.904 MW WEIM AVENEJI"VMCICTOK CA 8880/ 88 <br /> 1201) 461.9420 <br /> ICsID0sNIII In Tri/NsDW <br /> ANWA"ON N HM SY MADE TO TME SAN JOAOLRN COUNTY FON A PETSJIT TO CONSTRUCT ANDION INBTALL THE WOW DESCRIBED.TMS APPLICATION It MADE IN COMPUANCE NINTH <br /> JOAQUINI CCUWY MVROPMMr TRTT.E.C04APM O-1115.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRDWADITAL WALTH DIVISION. <br /> JOS ADDRESSIOR AFNtrq d CITY- S=AM# <br /> rARCEI <br /> owNER S NALII[ Cr AflpMy 7 PHONE s_ �sy <br /> Co!lrRAcroR V Li ADI)IIEss , LIC <br /> oy:? E r <br /> sus ADD1N947 UCNIFINONE <br /> ❑ NEW WILL ❑ REFLAcomw WELL ❑ Momome WELL ❑ OTHER <br /> ❑ INr'TAUATION ❑ WELL SYSTEM KWAIR ❑ CRosscoNNECT RErAIR ❑ VAPOR EXTRACTION WELL 0 <br /> (TYPE OF PUftAFI 1�Wis.❑R.P.Ir N.P. T mm P\8UP suArLrr. FIRST WATER LEVEL—_4 _ <br /> ❑,OUr-ORSERVICE WELL ❑ GEOPHYSICAL WELL I ❑ sat some <br /> ❑DESTIENCTION <br /> NHENEW <br /> ❑ ITDUSTRIAL ❑oP'EN DOTTOM DIA.OF WELL EXCAVATION OLA.OF CONDUCTOR CASMq <br /> ❑ DOMlSTICIR10VATE ❑NNNLVEL PACX►S12E TM OF CAW401STEELIpVC DIA.OF WELL CASINO <br /> ❑ FUBLICmut;wAL ❑omi" DEPTH OF GROUT SEAL SPECIFICATION <br /> ❑ INNSATLOTUAo ❑oTmm GROUT MEAL INSTALLED BV GROUT ARANO HAMS <br /> ❑ Mowrom G GROUT SEAL PImmi ❑Y« ❑N. coNCRErE PEDESTAL BY DRILLER:❑Y. ON. <br /> APN OX DorH LOCKING CHEWER SOX TTOVE PERE <br /> PROPOSER CONS RUCTgNIDISUING METRDo-. MUD ROTARY MR ROTARY AUGER CABLE_ OT"DL. _ <br /> 1 HEMBY COMFY THAT 1 HAVE PREPARED TMS APPLICATION AND TMAT TM:WOV*WILL VE DONE IN ACCORDANCE WITH SAN JOAOUIH COUNTY ORDINANCES,STATE LAWS,AND RULES i <br /> REGULATIONS OF THE SAN JOAOL Mi COUNTY. NOME OWNER OR LICENSED AGENT'S SIONATURK CERTIFIES THE FOLLOWNNOr'I CERTIFY THAT M THE FERFOMANCE OF THE WORK FOR WH <br /> THIS F I10W M ISSUED,I SHALL NOT EMPLOY PERSONS SUMJECT TO WORIMAN'N COMPOISATION LAWS OF CALN43M .• CONTRACTOR'S 1411000 OR VU61CONTRACTMq SIONATUM COM! <br /> THE FOLL0IIMINSs 'I CERTIFY THAT M THE Ft11FCWAtANCE.Or TNR WORKFORWINCH THIS PRIMVr I9499UED,4 SHALLALVLOY FERSOOS SUBJECT TO WORMIAN'S COMPONATMN UWW <br /> CALIFORSA.' THE ANT#TENT GALL 74 II ADVANCE PON ALL INGIIIMG INSMDOHONG AT 12M 46114472. COMPLETE DRAWING AT LOWER MEA PROVIDED. <br /> PLOT FMN Mfew h owl.] <br /> 1. NAMES OF STREETI OR ROADS NEAREST TO OR DOUNOINO THE FRDFERTY. 4. LOCATION OF HOUK SEWAGE OTSFOSAL SYSTEM OR N10FosE0 <br /> S. OUTLINE OF TMi"WPP T Y.WVIIINO OVIAEOBDNS AND NORTH DIRECTION. EXPANSION OF SEWAGE ONSP'OSAL SYSTEMS. <br /> �. DOWNPIONED OUTLINES APD LOCATION OF ALL EXISTING AND PROPOSEO S. LOCATION OFF WELLS WPTININ RAMS OF ONE HUNDRED FWrV FT. <br /> STRUCTURES,INCLVOWG COVERED AREAS SUCH AS PATIOS.DRIVEWAYS.AND WALKS. ON TIN PPIOPEMY ON ADJOINING PROPERTY. <br /> :.....:......:............:.... ............... <br /> a <br /> p.. <br /> ..y................ <br /> .... <br /> : <br /> ...F............t.... .. .......E .. �>..� .. .. .. .. <br /> f <br /> y <br /> ;......'..... ............ .... .. <br /> ..:.....;... <br /> .... ..... t.r......:.... .. <br /> y .p. <br /> : <br /> : <br /> .V <br /> .... .........:........... Me <br /> ......... <br /> ... <br /> : <br /> : <br /> : <br /> ;. ........:.............;.............;.......:.... .......:......:."'`� Aid <br /> y....:....................:............ .. >... ;... a;: <br /> ' P,�IV:10'1 ..�ft��-''a�� <br /> 1r <br /> 04 <br /> .. .. .. <br /> . .........`:...... <br /> .EIV:iI'I Rb <br /> :.....: <br /> . N <br />