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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIR011MENTAL HEALTH DIVISION <br /> P 0 BCX 388, 446 N.SAN JOAOUIN ST, STOCXTON,CA 96201 388 <br /> f209I 468 3420 <br /> NOM R[FUNORBI[PERMIT[%VIRES 1 Y�RR FROM ORT[ISYUFO <br /> IGRgI.IR M TFylhAul <br /> AFREICATION In HCFK BY MADE TO THE SAN JOAOUIN COUNT/FOR A FIAP.117 TO CONSTRUCT ANOTIR INRI AI I THE WOPR OFECAIA[O THIS APPLICATION I.MAD(IN CUUM.IANC(WrTM SAM <br /> JOAOVIN COUNTY OE'JTLOPMENT VILE.CHAF'T[q 0 11 S.3 AND THE STANDAMS OF SAN JOACAIIN COUNTY PVRIC I1r ALM VIC <br /> VER (S,INW%n NFAENTAL HEALTH N"SON <br /> JOE ADORESngR APN/ 17 . � G LkLe;[L CITY 'Ct PARCEL SIZElA 1 <br /> OWNEA'S HAMl�� S/ �i(•IN AtMR/ee ,AE// <br /> CONTMCTOR�1d�P /1 / /MC — -Af%Mltn[��/I/I�FCAS /RIL�DICI RINE <br /> fL?Z <br /> OUR CONTRACTOR p <br /> �.-1( AM1lSS MwF <br /> tic O / <br /> -� TVTT Of WILL/ im" 3 NtN WTIL ❑NFTACf M(N1 WTLI ❑RNINITII NO Wlll/_ ❑OrN(R �— t <br /> ❑INS,ALUTIOn ❑WELL SrPiiM n1 PAIR Cl CINIPP CONVECT RVPAIA ❑V.IPOR EXTRACTION WELL/ J <br /> ❑NR 01— M P IHPiH LMP NT__FT FIRST NATER LEVEL O - <br /> (TYA CF R/MPI <br /> ❑OUT OOFF.Nl1"WE WlI LL 1 /❑� 0(OMYNCAL WELL.TT--// �- ❑ SOK 6:4N0_ <br /> ❑DESTRUCTION <br /> INTW.DW U.E s� TYF1 OF will CONSTRUCTION SPICWKAtIONF A <br /> ❑INDUSTRIAL ❑❑Opts BOTTOM DIA.OF WELL EXCAVATION (� DIA Or CONOIK TOR CASINO '—I,___O R " <br /> OM"TIC/RWVATF 116.QMVEL RACK/SIZI Tl'FT 0/CANNQBTffIA'�k[_ DIA,OF WTI.L CANPJO , y O C- <br /> -� <br /> ❑R/BLIClMUNICIPAL ❑DRIVEN r*MH OF GROUT BEAR WCIfICATgN R <br /> ❑IRNOATION/M ❑Oman GROUT SEAL INSTALLED BY OROVT eMANO NAM[ C 4 F <br /> ❑MONITORING / CROAT SEAL.PI/MFTDXY_ ❑N. CONCRETE PEDESTAL BY LLE1L.❑\� � S <br /> AMPROX.DC►TM22, LOCAINO CIIWEA VOX/STO'J[RM <br /> FROPOSlD COMETRUCTOh'OIELLINO NIETNOD: M•JO RUTARY �NR ROIARY_ AUG(R CARL[ OTTI(A T- <br /> I HEREBY CE/TTIFY THAT I MAPF P TARED TI.S AML ATPON ANO THAT THE WORK WILL BE DONE IN ACCORDANCE WIIN I.M JOAQL/MI COUNTY ORDIMANCEe,RAFE LAWS.AND FSALS AMO <br /> KOVLATONS OF 1 ME SAN MADUIN COUNTY. HOWIG <br /> .OWNER OR LICENSED AO[NT'S SIGNATURE CERTIFIES THE FOLLOWING 'I C[RTIEY THAT W THE PETL/OMAAFK!OF TH[WOFK FOR WI11CH <br /> THIS PERMIT to <br /> ISYLIFD,1 SMALL NOT FMR"OY KRSONS SUMCT 10 WORXMM'S COMFOFSATIOM LAWS OF CALIFORNIA.'COPFTFUVTGR'S MNV/O OR""NTRACTNO YOMATUF(CERTIFYS <br /> THE FOLLOWING: 'I CERT'FY THAT W THE FEIVOAMAPWf'r THE.HOFS:TOR WMKH THIS 1TRMfT IS ISSUCU.1 SMALL EAIPL.OY ARSONS SUBJECT TO WOREWM'S COAMSIISATION LAWS OF <br /> CALIFORNIA.' THE AM/1yC-AANY WV�f T�CALL <br /> 24 HOW IN AJVAFFC[FOR ALL ASSURED INSPICTgMe AT LOBI ANJA37.CONIFER[DRAWING AT LOWER AKA Plq'M". y^ <br /> . NR/rd 7,� `tJ 1• Ulll2it �fE�___ Ti _ 1,[I01A DN. <br /> nor FtwN Io-.N I.9. rww <br /> I. NAMED OF STREETS OR ROADS NFAR(ST TO OR Tq UNDINO IP1[PROPERTY. A. LOCATION OF HOUSE SI AO!OISMSAL SYREM OA RIDFOSIU <br /> }.OUTLINE OF THE PROPERTY,OIVIWJ D"ENNON.AND NORTH DIFECTICN. EXPANSION OF SEWAEIE DISPOSAL RY/TEIRS. <br /> '1. DINIENSIONED OVTLPME■AND LOCATION OF ALL"IFTING AND 11g ID S.LOCATION OF WFUS WTTMDAMMK <br /> N MAS OF ONE HI(1D FIFTY R. <br /> STRUCTURES,INCLUDING I'OVERFO AREAS SUCH AS­1 ORVEWVAYS AND W-.XS. ON THE FMOITRTV OR ADJOINING NOFERTY. <br /> Grlc uc L l_a Al <br /> o� <br /> E <br /> �oo-f <br /> pl <br /> I � harn <br /> X11 1 N PAYMENT <br /> PI ,F.y � f RFCE1Vrn <br /> AUG 2 2 1995 <br /> PUBLIC HEALTH CUuV'f <br /> ENVIRO( NgFNTA SERVICES <br /> LHEALTH r/ <br /> DL'MTM[NT U.!ONLY <br /> AF.nR —A..R W BTS <br /> + GIwR I..F•.r+Hn eT h/�l:v'/T L l D.l. �I >L._-lJ-F1++P L+P.=I�.n nr —Dom,_ <br /> t...ouell..1 S�..Rl.en er w1.— — <br /> ___—z— `rte <br /> ACCOUNT")"ONLY. <br /> K Coo" rn rNw AMOUNT R(dl11TTED rw[c■/}C AFw REc av[O Fr Da rx FOR.11/16MC[ILE.Uf.T Pf. SM IMV^ICE <br /> t <br />