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NOW-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (CBmp1Eb 1R TTy10BStSl APPLICATION 16 HERE BY MADE TO THE GAN JOgOVIN COUNTY FOA A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED,THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAOWN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1115.3 AND WE STANDARDS OF SAN JOAOUIN COUNTY PUSUC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDREOSIOR APN#_;t J 75-0 F— R 1 eyn 1C !L CRY_ SGA, L'J i/j PARCEL SQE/AiWF S�D GLY'C�S OWM OWNER'S KA O 1�! Gr/' ri"G Y'w.S tnG ADDRESS� f Fl 1 VG. IV�_ PHONE I CONTRACTOR ADDRESS lN:# PHONE SUBCONTRACTOR ADDRESS LIC# PHONE# TYPE OF WEILPUMP., ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# 1 ❑ OTHER_ ❑ INSTTAA LATION 11 WELL SYSTEM REPAIR 13CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL I $JMP TT__,go,10NRR1Y 1, N.P. DEPTH PIMP SET (TYPE OF R —FT. FIRST WATER LEVEL I� I� ❑ OUT-0"ERVICE WELL 1:1GEOPHYSICAL WELL P ❑ SOIL Sam" t- ❑DESTRUCTION: C)1 INME WeY W CONS ACTION SPECIPICA ONS `\ \q ❑ R10VSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION CIA.Of CONDUCTOR CASINO O ❑ OOMESTICJPNVATE ❑wAVEL PACKMQE, TYPE OF CASINGISTEEIJPVC DIA,OF WELL CAMNO )D ❑PV6UEMUN CICWAL ❑OSIVEN DEPTH OF GROUT SEAL SFECIFICATION ` R ❑ INTOATONlAG ❑OTHER GROUT SEAL INSTALLED BY OROIR BRAND NAME E ❑ MONITORNIG GROUT SEAL PLMPEO: ❑Y" ❑NO CONCRETE PEDESTAL BY pPLLEA:❑Yw ❑NO 5 APPAOX.DEPTH U)"I Nl CHESTER boX OW PPE mom mCONITSUCTION NOW"METHOD: MUD NGTAIM AIR ROTARY AUGEq^- CABLE OTHER I HEMBY CERTIFY THAT 1 NAVE PREPARED TWO APPLICATION ANO THAT THE YYOHL MM BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES,BTATF LAWS,AND MKS AND REGULATIONS OF THE BAN JOAOVIN COUNTY, HOME DWNER OR LICENSED AGENT'S SIGNATURE CERT"S THE FOLLOWING:7 CERTIFY THAT IN THE PERFORMANCE OF THE WOO(FOR WHICH THIS PERMIT 16 ISSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WONKMAN'S 00MP@ISATION LAWS OF CALIFORNIA.- COM RACFoR'G WHIMS OB SUBNNTTACTIHO SIONATURE CE"IPES THE FODUR I T: -1 CERTIFY THAT M THE PERFORMANCE OF.T.HE WOM FOR WHICH THIS PERMIT 1/ISMIEO,I SHALL EMPLOY TERSONG GUSJECT TO WOROAAN'S COMPENSATION LAWS OF 6 C�tl M11A.' THi�� ^ADVANCE POR AU.R[W,,1�TNINO AT IM 1 YBJLZE. COMPLETE DRAINING AT LOWER AMA PROVIDED. r/Gy D.I. 2 Z SF 7 PLOT PLAN O.w SnHel S.1. t. 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDINO THE PROPfPTY. A. LOCATION OF HOUSE SEWAGE OPIN'09 L SYSTEM OR pMMSED 3. OW ME Of THE PROPERTY,GMNO MMENOONS AND NORTH DIRECTION. EXPANSION OF GEWAOE CNIMSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION Of ALL EXISTMO AND FROPOSED S. LOCATION OF WELLS WRIRN RADIUS Of ONE HUNDRED FIFTY FT. STRUCTURES.INCLUDING COVEPED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING FROM". s cr.Jc � S i c�vt Co!1;cv F'aLrrL,a f,+Lc., _ DEPARTMENT W E ONLY ' APPIIOImpo Aneemed SY pHa "l ryy GIOA IrBPOcllen Bye Dtle PvnP IrupsilOn sr Dab/ DaHwGM 1rRpsibn Br D.L. Camn»mc_ ' ACCOVNTINO ONLY: AID# cqu