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APPLICATION FOR WELL/PUMP PERMIT Vdae�6 <br /> ( � SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> v - ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> -� VOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> Momp18t1 M Tr*lntel <br /> APPLICATION HE NESE SY MADE TO THE SAN JOAOUN COLINIY FOR A PERMIT TO CONSTRUCT ANDgR INSTALL THE WORK DESCRIBED.TIPS APPLICATION 16 MADE IN COMPLIANCE WITN SAN <br /> JOAOIHN COUNTY DEVELOPMENT TITLE,CHAPTER 5-1115.3 AND THE STANDARDS OF BAN"AWN COUNTY NIBW HEALTH SELVICES.ENVMONMENTAI HEALTH DIVISION. <br /> JoeAD01ESSORASNE 101 S. REID, LINDEN CRY LINDEN 95236 —PARCEL VZVAMI <br /> OWNER's"AA,ERONALD GONSALVES APEPSE,SAME FHONE1462-6403 <br /> CONTRACTOR NOACK W/0 FNHW ADUNESS 4500 E. FREMONT ST., 504513 FHONE1948-8817 <br /> BvsCONTRWTOR ADDREp STOCKTON, 95215 LLet PONES <br /> TYPE OF WELLSN .. ❑ NEW WELL ❑ RERACEMENr WELL ❑MDMTORNO wELL I ❑ OTHER <br /> ` ❑ METµAyL ATDN ❑WELL SYSTEM REPAIR ❑ CROSSCONNECT RSPAIR ❑ VAPOR EXTRACTION WELL I ✓ <br /> SUBMERSIGLE ❑NP.POlMPSI. N.P. 5 UE"H PUEAP SET FT. FIRST WATER LEVEL o <br /> PE <br /> ryYOF PUMP1 xy�g2�1 - <br /> REPAIRS TO 1XTSTTNG6PUMP OUoF-SERVIC <br /> rE WELL ❑ GEOPHYSMAL wELL11I MR wavia S <br /> ❑DESTRUCTION: <br /> INTENDED USE TYFE OF WFLL CONSTRICTION SPECIRCATIONS A <br /> 11 <br /> W USTRIAI ❑IPmH WETOM DIA.OF WELL EXCAVATION EIA.OF CONDUCTOR CASINO D <br /> In DOMESTICMRIVATE ❑OMVELPACKARZE TYPE OFCA9NGMTEEIIPVC MA,OF WELL CASINO <br /> ❑ PVBtICIMUNICMAt ❑MRVEN DEPTH OF GROVE SEAL 5E4CINCANOH S <br /> ❑ MRGAVON/AO ❑OTHER GROUT SEAL INSTALLED BY GROW N NAME E <br /> ❑ MOMTOWNO GROUT SEAL PIMPED: ❑Yr ❑Ne CONCRETEPMESTLLBYDWLLER❑Y- ❑Ne 5 <br /> - APNLOX.OEPTH LOCKING CHESTER SOXnTOVE PRE 5 <br /> PROPOSED COMIRWTIONIDISUlNO METHOD: MW ROTARY AIR NOTARY AWES CABLE OTHER <br /> - 1 W WBY CERTIFY THAT I HAW PREPARED TRBS APPLICATION AND THAT THE W(MPZ WILL BE DONE N ACCORDANCE WITH SAN JOAOVIN COUNTY ORDINANCES.STATE LAWS.AHD RULES AND <br /> REGULATIONS OF THE BAN JOAOIIIH COUNTY. HOME OWNER ON LICENSED AGEM'S SONATMW CEWWWS THE FOLLOWING:'R CERTIFY THAT N THE MATOPAIANCE OF THE WOW FOR WNOH <br /> THIS PERMIT IS ISSUED.I SNALL NOT EER'LOY PERSONS SI RJECT TO WORKMAN'S COMPENSATION LAWS OF CAIFONMA.- COMRACTOR'8 MIRING OR MIB GOHTMCTNO SIGNATURE CERTRRS <br /> THE M(LUVANO: •1 CERHR THAT N THE PERFORMANCE OF THE WOM EOR WIMP THIS PERMIT IB MOVED.1 SHALL EMPLOY PERSONS SUB.lECT TO WOINMAN't COMPENSATroN LAWS OF <br /> CALIFORNIA.- T11E AMM H HOURS IN ADVANCE FOR ALL AMIMEO INSPECTIONS AT UMH 4tl4M". COMPCFTE DRAWING AT LOWER MEA PIDVIOED. <br /> MP—E X T,K, RETATL SALES OR, 9/25/49 <br /> nor PLAN n>....I.eery Ba.l. •ro <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR POUNDING THE ROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> S. OUTLINE OF THE PIOn1TTY.OWING DIMENINONS AND NORTH DIFECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> T. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND FHOPOSEO S. LOCATION OF WILL$WITHIN RAINKM OF ONE ARMORED FRT'FT. <br /> STRWTVPES.IMLMANIG COVERED AREAS SWH AS PATIOS.MVEWAYS.AND WALXe. ON THE P OPENTY OR ADJOINING PROPERTY. <br /> / ,�Clii/c°14ef� <br /> Lcs a <br /> a <br /> PAYMENT <br /> a3EcEIvEp <br /> NOV 231 9 <br />