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APPLICATIRN FOR WELLIPUMP PERMIT <br /> "') /'.4✓ SAN JOAQUIN ,VTY PUBLIC HEALTH SERVICES <br /> I ENVIROflMENTAL HEALTH DIVISION v <br /> P 0 BOX 388, 448 N.SAN JOAQUIN ST,STOCKTON,CA 96201 38B <br /> (209)468 3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICnmp6w In h Alio N <br /> APILCATWN IB HEIS BY MADE TO THE&W JOAWIN COUNTY FOR A FEPMIT TO CONSTRUCT ANVOR INSTALL THE WOIK DESCNBED.THIS A}WICATIOH IB MME IN COMPLIANCE WRH RAN <br /> JOAWIN COUNTY OEVELOMENTL CHMTFP AN <br /> B-1 16.3 O THE STANDARDS OF SAN JOAQUIN COUHR,PM M HEALTH BEPVICES.ENNIIONMEMA HEALTH qN <br /> JOB ADOPEB&9R AW- J�'��/`^JJ F�, . .F �/.� CRY v � /��/� PARCEL WVAPN! J <br /> CQ AJI AL— NCC ADDRE88 �/ S41AYC PNONE, c -2,5 <br /> CONTR'BNAME WI �//F-2 Scow- L E <br /> CONTRACTOR ���I ��"�L"-�� Y C/,4rTC4 kN� UCI RFONEI <br /> SUB COMRACTOfl ADDRERB YGt PHONEI <br /> TV140f NRLDWMP: �NFW N4LL ❑P IUHEM NTLL ❑MOMTOMXO WELL/ ❑OTHER <br /> ❑WSTAWTpN 11 WELL SYSTEM REPAP ❑CPOBbCONNECT REPAIR ❑VAPOR EXTMCTpN WELL• J <br /> B1/.0M1pMr H.P. DEPTH MNMP SET_FT. FIRST WATER LEVEL O U, <br /> V1 <br /> GYM OF MMPI ❑OUTOFBFPNCE WF11 ❑OEOFHYSKA WELL I BOR BONING S Ul <br /> c <br /> ❑DESTRUCTION: <br /> INT-p-USE TYPE OF WELL Ca,u,RUcTIOn SMOCIIICA• AS A N <br /> 60 NyVSTPIAL ❑O/PEN BOTTOM CIA.OF WELL EXCAVATION V I2- �/ DIA.OF COWUCMRC"NO N� O <br /> yl NIISTKIPNVATE 0.GAVEL PAC .8_E �/ TYPE OF CASINGRTEELWC /O�SFNCC� _ VA.OF WELL CASING Ll <br /> IY OZ <br /> ❑RIBUCIMUNICIPA ❑DRIVEN DEPTH OF GROUT SEA 2(V/ BPECIFKATKN � AL./GK N{— ' I x <br /> ❑INUGATWNIM 11 OTHER SPOUT BEA INSTALLED BY C� GROUT BRAND NAME WC `SIC 'v Ec-f, <br /> F C'81�UT SEA PIMPED. - ❑NN CONCRETE PEDESTALBV gYMEM1' ❑Nn <br /> ❑MOHROWNG �(1� �D <br /> AMNIO%.OFFTN LOCKING CHESTER BOR/BTOVE PIE 'T <br /> TDPottD COXSTRUCTIOMTMWND MFTMOD: MU.ROTARY <br /> AIR <br /> ROTARY AUGEfl CABIE GIRDED ^ <br /> I HERESY CERTIFY THAT I HAVE PREPARED THIS AFFMATION.0 THAT THE W W WILL WE DONE IN ACCORDANCE WRN BAN JOAW W Ud <br /> CONTY OPNANLEB.STATE UWP.AHD RUIER AND <br /> REGULATFRNS OF THE BAN JOAQUIN COUNTY. HOME OWNER OR MOVES.AGW'S SIGNATURE CERTIFIER THE FOLLOWING:I CERTIFYTHAT IN THE PEKOWAAICE OF THE NOIR TOP <br /> THIS PERMIT IS 1.....1..W.NOT FNN.Y RRSONS SUBJECT TO WORKMW'S COMPENN.TNV LAM OF CALIFORNIA,' CONFMCTOR 8 HIRING OR SU"ONTMLTINO SIGNATURE CERTIFIES <br /> THE FOLLOWING: -I CERTIFY TNA H RF011MANCE OF THE WEIR FOO WHICH THIS PERMIT 18ISSUED.I SHALL EM0.DY FUSIONS SUBJECT TO W=AL <br /> COM ATgM LAWS OF <br /> CALFdW1A'/T/1'E/{IlJ1/F(/B/UC T T 7=ADVANCE ADVANCE FOR ALL REOGN ED INSMGTpNR AT 13881 AY-STIR.COMRETE DRAWING AT LOW N1FA FPO <br /> PLOT RAN ID,—Ia S -)R 10 <br /> Wr <br /> NAMES OF STREETS OR ADS NEAROP Y <br /> EST TO BOUNWNG THE FNOF . 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYBIEM ON RYJWSM <br /> 2. OUTLINE OF THE PROPERTY.GIVING DIMENSIONS AND MOWN DIRECTION. EXPANSION OF REWAOF gBIOBAL BYBTEMB. <br /> ]. DIMENSIONED OUTUNFS AND LOCATION OF ALL EXISTING AND FTOFOBED 8. LOCATION OF WELLS WITHIN MDIUR OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATKB,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING REORRTY. <br /> 6uLI�IH�� 4 <br /> It <br /> — F <br /> Sen�� <br /> PAYMENT <br /> PF4':FIV"rl <br /> SEP - 5 1995, <br /> ,AN JOACUnV cGUAI-f I' <br /> PUBLIC HEALTH SERVICE;. <br /> �NVIRONMENTA U-1 <br /> > <br /> DEPARTMENT ME ONLY OI Q J 7 0 <br /> AMllulbn Aeclttl B / J <br /> �Y—X-`7.�Punp ImpsNm BY �4 <br /> Grern Inpaellm By V <br /> D�Irrc.bn IrRM[INn By MM <br /> A<coUNnxo ONLY: Slot FAC4 <br /> M CODES FEE INFO AM UNT P[MPTED CNEC MX DECOYED BY DATE —.Tl.--.E AMMAT NUAFEP INVOKE <br /> 2 <br />