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..,,.........u.. .. ul.umr rL I—. <br /> AQUIN C <br /> �J SAN JOOUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 38A 304 EAST WEBER AVENUE,STOCKTON, CA 95201388 <br /> 1209)468.3420 <br /> ROII•REFUNDAILE PERMIT EXPIRES 1 YEAR FROM LATE 13lUED <br /> Maimpkt@ Is TrlptkEtt} <br /> APPUCATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDICR INSTALL THE WORK DESCRIBED.THIS APPLK;At10N IS MADE IN CO jmIANCE WRH EAI <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-111 5.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUSLIC ALTN EERV4CES,ENVIRONMENTAL HEALTH DIVISION. <br /> � I <br /> JOB AOOREDtgq 0 ! CITY . .��itr PARCEL VZFJAPNI <br /> OWNER'S NAME_ �/ I H ADDRESSp/^ �,/`,[� �L1��LfyJ''� PHONE 423 <br /> CONTMCTOR_1A j' l l I r /!5`/(!JP^f_�i !7 UC4�_PNOHE L3�G I!Z• <br /> AODRESB <br /> SUS CONTRACTOR H�T,11 ADORESE LRCS—_ PHONE F <br /> TYPE Of WEUIVVMP: t4t,•FW WELL ❑REPLACEMENT WELL ❑MONITORING WELL/ ❑OTHER_ <br /> ❑INSTALLATION ❑YVELL SYSTEM RF►AA ❑CRCSR-CONNECT REPMR ❑VAPOR EXTRACTION WELL E J <br /> (TYPE Of PVMPI <br /> 13m— m, i, H.P. DEPTH NMP BET T'FT. FIAST WATER LEVEL t[ D <br /> •� � %� " �©L� <br /> OUT-OF-SERVICE 1J WELL OEOFHYSICAL WELL E I SOCL/ORINO <br /> ❑DESTRUCTION: <br /> IN OF U TY-=W CQ"TRVCIIOIW SPECIFICATIONS A <br /> ����❑(•INDUSTRIAL ��❑I�7OP�E��NEOTTOM VIA.OF WELL EXCAVATION DIA,OF CONDUCTORCAMNO D <br /> +9,.,.MEETICTRIVATE (: UT RAVTL PAW91ZE TYPE OF CASIMISTEEVPVC DIA.OF WELL CASINO F D <br /> ❑PUSUCIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL SPECIFICATION A <br /> ❑IRWATIONJAQ ❑OTHER GROITr SEAL INSTALLED BY L4 l[ _ GROUT*RAW NAArt �' t <br /> ❑MONITORINO , I f 1 OR.-SEAL PUMPEOM . ❑N, CONCRETE PEDESTAL Sr NLLFR:Q Yw J <br /> APPROX.DEPTH l� LOCKINO CHESTER SOXATOVE PIPE s <br /> PROPOtm CONIMUCTIO NlOPRWNO METHOD:MUD FRIARY '�,k AIR ROTARY ���_AUGERCABLE OTHER <br /> I HERESY CERTIFY THAT 1 HAVE PREPARED THID APPLICATION ANO THAT THE WORK WILL.OE DONE IN ACCORDANCE HATH SAN JOAOTAN COUNTY ORDINANCES,STATE LAWS,AND RULES ANC <br /> REGULATIONS OF THE CAN MAQUIN COUNTY.NOW OWNER OR LICENSED AGENT'S EIONATURE CERTIFlES THE FOLLOWING:'I CERTIFY THAT W THE PERFORMANCE OF THE WOIK FOR WHICF <br /> THIO PMM(T It ICSUEO,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORUOAAN'S COMPENtATToN LAWS OF CALPoIpaA,'CONTRACTOR'#WAINO OR WS-CONTRACTING 94NATURE CEATME( <br /> THE F011DWMG: 'I CERTIFY THAT IN TH!PEAT-0RMANCE OF THE WnPK FOR WHICH 7H1/REPBAR It ISDUEb,1 SHALL EMPLOY PERSONS SUBJECT TO WORJUM'S COMFOISATION LAW@ 01 <br /> CAUFORMA.' THE APPLICANT MUST CALL AA HOURS IN ADVANCE FOR ALL REQURm INSPWTIONR AT 120@1 440-3472.COMPLETE DKAWINQ AT LOWER AREA PROVIDED. <br /> wo—d X t C �•1/ A-�.IN _T111, <br /> PLOT PIAN IDfw,la MMI SvIA 1. <br /> i.HARASS OF KREETI OR ROADS MAREST TO OR @OUNOPM THE PROPERTY, A. LOCATION OF HOUSE SEW AG!dSPOEAI SYSTEM OR PROPOSED <br /> Z.OUTLINE OF THE PROPERTY,OWING DYMENSONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS• <br /> 7.DIMENSIONED OUTLINES AND LOCATION Of ALL EXISTING AND PROPOSED S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT, <br /> STRUCTURES,WLUO(NG CO VERSO ARE"SUCH M PATIOS.DRIVLRVAYS,AND WALK& ON THE FROM TY OR ADJOINING PROPERTY. <br /> : <br /> A. <br /> en <br /> • i yam..: :....:. � � _ .. - <br /> y: <br /> y.. • <br /> : <br /> �j�� <br /> : <br /> .k <br /> & I <br /> .....:... ...>.. :.. .:......:. '•...?� '.....'. `'fir..; • <br /> V <br /> : <br /> wofl :.... <br /> T• <br /> al. .,.o . ... > . <br /> DEPARTMENT Us.ONLY <br /> or.,A NPAeII„, <br /> By- � I OA1O j2'19-4T�•,,,P lrnpw(len BY D.T. <br /> • Imo, — <br /> OwouaU,,,Ie.P.eelen 9r C�1•.w-�`� �;: [1'� �L•a-C< yy;; <br /> CemmKle,: GIx L�LAyI ,I 1 TVO �V IT I/R• S <br /> O✓� 'f'Lt(5 WIMi-� -O Gredli" 9H YttLcf- �'�y� Lr yy}. <br /> ACCOUN/ONO ONLY: AIRF FACE <br /> PE CODES FEE IWO AMOUNT PJMMYT03 CNWKFrCAAH REOOVED BY DATE PPNATISCIVItf ACQU987 NWB%R Oct1NVO <br /> �r3(plo 110 I go.Q(7 SIP 03 <br /> ;,iL�� � '�• 5o So •o o (B I 5 iia 9 a���LL ' <br />