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n APPLICATION FOR WELLIPURIP PERMIT <br /> BAN JOA4UIN COUMTT PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P-0-BOX 988,904 EAST WEBER A CI <br /> ,SZOCYOI4 CA 98201.988 'Ir-'N <br /> j I[20)1 R8B-3420•a42o 1� <br /> t p B!E <br /> POWIT,OMAIR <br /> i <br /> APPUGATFON M HERE by MADE TO THE SAN JOAOIIOR COUNTY FOR A PERMIT fO CON6TRUCT ANDion INSTALL THE%vow Diser ED.Two AFFEICATION I/LIADE p9 f.ONE+IJANGE WIN/µ <br /> JOAOISN COUNTY OERIELOPIiIENFT TIR£N�CHJW`�M 9.11-1-6—.-9�AND THE STANDARD/OF SAW JOAOWN COUNTY PUBLIC HEALTH SERVICES.ENVNIDNMEWAL HEALTH DMEION• <br /> .6 At..AFW�R�� �) 1 LiC'�QC �A _CITY � •\ PAIRYL 81ZFJAPK/ <br /> OWNWO NAME ,p_ _ ADDRM r \Vl PHONE✓ la?'o► o <br /> caTrrRAGTOR���I<t'CgF�.��ure.��Sq�I���� AooREn�1�����t'n�.\NAIL Llcs�(�F�wHE���I <br /> SUICONTHAICTo14- — -- .._..._,.,. �ADONIEU Lmad <br /> rr-11T "ONE I <br /> Y4ttLATIfA►: (3NRN wu 0 AOLAWKENT TMELL LSI MawToeNO WELL E O OTNERL_ _ <br /> O ILFULL.ATION 0 WELL/WTEM REPANR ❑ORONOCIR Q OMMECT REPAIR vAPOR EXTRRCTION WELL IF <br /> Nrr IIgN.1I Hr•�� DEPTH PUMP EETINILPT, PRINT WATtlI!•E1Ip� _ f1 <br /> rryPE OF FLRAPJ <br /> Cl ovT-0FIERVRCE WELL ❑OEOAIYEICAL WELL• ❑ NDn.SOANO S <br /> ❑aEerRucTION: . <br /> Mom— <br /> i <br /> O A <br /> ,113 mmumAL CI OPEN/OTTOM DIA-OF WELL ERCAVATgN DIA.OF CONDUCTOR CAEMD D <br /> i�L DOLESTIC/PMVATE GRAVEL PACKim1E_ � TYPE OF CANNOMITEEI.VNC OTA.OP UYELL CA/!NO p <br /> ❑Fgjmm.IVNtP'AL ❑OIIVDI OWN OF GROUT SEAL YPECIFICATION R <br /> cl IRRRIOATIONFAO O OTHFII GROUT SEK DFTALLIED Sym— OROUT MWID HAMF E <br /> ❑MON/TOFFND umvrREALPUMPED:❑vr I]w CONCRETEPEOE/TKNYDIA.LET I3Yr Ow 8 <br /> AI'PRON.DOTH, t 1�"Iw LOCKM CHESTER MXWTOVE PN'E <br /> PNL4Oi®CONSTRUSTIONnouLISNO MRNoo, MUD ROTARY AIR ROTARY AUOER CANE OTHER_ <br /> L HEAFJIY CERTIFY THAT 1 HAYS PREPAIEo THNI APPLICATION AND TMAT TIRE WOR(WILL OE OOKE M ACCORDANCE VMITN SAN JOAOURI COUNTY ORDINANCES.RATE LAWS,AID RUES AKD <br /> MOIAATIONS OF THE SAN JOAOLPII COUNTY.RMOAM OWNER OA L1CFMl Eo ADEM'/SIONATIRE CERTIFIES THE POLLONOVO:R CEfRPY THAT N THE PERFORMANCE OP THE WOM FOR WMH <br /> TRI/lFISAT b 1[IUEO.1 SHALL NOT EMPLOY FUMM EUSJECT tO VMMMANY DOMPDMATION LAWS OF CAUFONNA.'CONTRACTOWI MMM OR pM CONRTLAOTUA OMATURE CERTLFIEff- <br /> THE FOLIOWINO! •I CEWWV THAT M THE FEIMOISIIANCE OF THE WOR[FOR NRLICH TNI/PERMNTLS MKW,1 SHALL EMFIOY PER/ONS SUNJECT TO WOIFSMAN•S CDMPDIYTION LAMS OF. <br /> " <br /> { <br /> CALIFORNIA.*TM APPMART MU/T CALL M HOIST/N ADVANCS FOR ALL NVKW D IIIM TRIM AT f2ID 4=4423.COMPLETE ORAWNO AT LOWER AREA PIIDVIlofm <br /> Er"K <br /> f@ <br /> PLOT FLAN IOrwY le SlfY.)SeAI. •m m <br /> t. NAIFES OF BTIFPTF OR ROADS NLMWIrT TO OR DOUNDRIO THE PROPERTY. /. LOCATION OF HOUSE SEWAOE OISPoSAL SYSTEM OR PIoIOIED <br /> SIO <br /> !.ORITLPG OP THE FRONERTY,GUANO DIMENNS MLO NORTH DIRECTION, FfWANWOM OF SIWAOE DISPOIAL SYSTEIM. R <br /> E.OIMEKMNM OUrUWP.s AND LOCATION OF ALL EI1fnNO AND FKOPOSEO F.LOCATION OF WELLS WTIIN IIADRF/OF aNE NIUNIOIE6 FIFTY FT- <br /> STRUCTURES.INCLUPM COVERED AREAS SUCH AS PATIOS,OISVEWAYs,AND WALK& ON114 PROPERTY OR AMMUNIO gWFEMY. <br /> . .... ..., i `....:, <br /> �.� <br /> 1 <br /> ... : <br /> .v. <br /> ' L.. .... 71I <br /> 1 J <br /> NMS, <br /> L <br /> OEFARTIUMIT USE ONLY <br /> AWNelUen Arps/ST— <br /> Nr . <br /> Gr 4mm..d—NF IalA q,mP Intp.otl.n!T DIME <br /> D-u--MOA Nrpanhn dy <br /> Wt. <br /> Gwnn,era• <br /> ACCOUNITSTp ONl 1RIDF PAGE <br /> R CODER AMOLRIT R&AMTSO NEC NCASH RELL'BVHI ov DATI PDNNTAERYMM MOLIEIFT NLoA R DVON:E <br />