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OW. OF WELL CASINO <br />SPECIE/CAT/ON <br /> <br />OROUT WAND NAME <br />FM, OF CONDUCTOR CASIINO <br />/0 " <br />g..,kEW WELL 0 REPLACEMENT WELL <br />INSTALLATION 0 WELL SYSTEM REPAIR <br />NaN 0 Paamir H.P. <br />ouT•os-stxvics WELL. <br />0 MONITORING WELL I 0 OTHER <br />0 VAPOR erraukc-no44 t4LI. s . r <br />' FIRST WATER LEVEL 6 <br />0 SOIL OOHING S <br />DESTRUCTION- <br />INT DED <br />0 INDUSTRIAL <br />0 DOMESTICJPRIVATE <br />0 PUSUCWIUNICIPAL <br />bErIFIRICIATIOINAG <br />rrrs OR son.L. <br />0 OPEN NOTTOIA <br />rrNORAVEL PACK/SIZE <br />0 DRUM <br />0 OTHER <br />0 MONITORING <br />corosnwonols SPECIPICATICIPM <br />DIA. OF WELL EXCAVATION <br />TYPE OF CASING/STEEL:PVC <br />DEPTH OF (TROUT SEAL <br />GROUT SEAL INSTALLED BY <br />GROUT SEAL PUNIFECOY. No <br />f14... PROPOSED CONISTRUCTIONORSLING MURDER MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br />A <br />CONCRETE PEDESTAL BY ILLIR 0 YM RSA <br />APPROX. DEPTH ge90 LOCKING CHESTER BOX/STOW PPE <br />TYPE OP WELIJPUNIP <br />(TYPE OF rosin <br />0 CRON1-CONNECT REPAIR <br />DEPTH PUMP SET FL <br />0 GEOPHYSICAL WELL, <br />APPLICATION FOR WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />PO. BOX 388,304 EAST WEBER AVENUE, STCICKTON, CA 95201-388 <br />(209) 413113420 <br />NOWIRFUNDABLE KRIM fOIRES I YEAR FROM DATE ISSUED <br />feampisis h Triplisaml <br />APPLICATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERNITT TO CONSTRUCT MOTOR INSTALL THE WON( DESCANTED. THIS APPUCAT/ON IS *ADE IN CDRIPLIANCE WITH BAN <br />JOAQUIN COUNTY DEVELOPMENT rrn.L. CHAPTER R-1116.3 AND THE STAN Of ILAN JOAOUIN LOU PUBLIC NEXT SERVICES. ENVIPONNIENTAL NNALTH <br />JOE ADDRESS/OR ARM c2 .6' 141.41 e odic <br />PAR EJAPHI <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORE WILL BE DONE IN ACCORDANCE VITTOI IAN JOADUIN COUNTY OFIENNANS, <br />REGULATIONS OF THE SAN ioaOLIIN COUNTY. HOME OWNER OR Liman AGENT'S IMMATURE CERTIFIES THE FOLLOiMINE 'I CERTIFY THAT IS THE PERFORMAPICS <br />THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPINSADON LAWS OF CALIFORNIA. CONTIIACTOWS MMHG OR SUSOGINTNICIPIO <br />TI* FOLLOWING: ' I CERTIFY THAT WI THE PERFORMANCE OF THE WORK FOR WHICH THIS motion- IS ISSUED, I SHALL EMPLOY PEP:SONS SUBJECT TO WOOMISMAIRS <br />CALIFORNIA-.PR *ppm my MUST C 24 HOURS WI ADVA/IICE FOR ALE REOUIRED I 110114 AT 4209I 41•3422, COMPLETE DRAWING AT LOWER AREA <br />X' <br />I <br />nit <br />I 1te <br />040.2 <br />STATE LAWS. MO PAJLES AND <br />OP THE WOW FOR WHICH <br />SIGNATURE CETITIF1ES14 <br />COMPONIATION LAWS 01‘ <br />PROVIDED. Ir <br />.---.2 tal.-97 a TINE Noma X t f f...._ <br />PLOT PLAN i0Greo to Scala, Scala ' to <br />S. NAMES OF STREETS OR SCADS NEAREST TO OR POUNOING THE PROPERTY. 4_ LOCATION OF HOUSE SEWAGE DM/PHIAL <br />1. OUTLINE OF THE PROPERTY, OPANG DIMENSIONS AND NORTH DIRECTION. EXPANSION OF *WRACK DISPOSAL *farms. <br />3. CIMENNONED DUO-NIES AND LOCATION OE ALL EXISTING AND PROPOSED I. LOCATION OF WELLS WITHIN RAOUL. <br />STRUCTURES. NCLUDINO COVERED AREAS SUCH MI PATIOS, DRIVEWAYS, AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br />SYSTEM OH PROPOSED <br />OF ONE HUNDRED FIFTY FT. <br />. <br />' <br />: . <br />../c....---. <br />• • <br />•=. <br />. . <br />, <br />. . <br />- • . ...t - .. . • <br />.. <br />. . ' . <br />. . . . <br />. . . <br />' <br />\ <br />. ... ..... .... <br />. <br />• <br />. <br />'• • ' • <br />: <br />. <br />: - <br />. <br />. .... <br />• <br />............. <br />.. <br />. , . <br />... <br />I. . <br />. <br />. • • <br />. '. ... <br />: <br />• . . <br />. <br />. <br />. : ... <br />: <br />. <br />.. <br />... .. <br />— • <br />. <br />.• . . ;.>,..iii.vJt <br />.. . . : <br />, - - . E. ....II B. $ 4W---;-----7,-. : <br /> <br />. . . <br />w_.e.4 ile-r-4.— L. <br />. j. ' -I".•,' ,7 L-e-.,.- I • ? . ._. ....,):,....: , ' AL <br />..., . DEPARTMENT USE ONLY <br />Data .2"/.2.5 /1'7 <br />H DIVISION. <br />21 2, <br />Applkaalart Acoapiad By <br />v.—p.p.. Sy Organ impaction Sy Data .42437 <br />. a DeatnartIon Impactioa By <br />Cornmanta <br />ACCOLNONO ONLY: ACE <br />PC CODES FEE INFO AMOUNT MATTED IRO ASH RECEIVED By DATE PIERAIT/SERVRE REQUEST NUMBER INVOICE <br />41't ro . ,,-- -wvit)-3 . tb .)./.7.5 D 35 407 7 Li -3 • 69 iet) <br />_ <br />OWNERS: NAME 7:-,•••,/y . C 1 <br />CONTRACTOR A/4 it /4 1( tf / IT t/ly Iic <br />SUS CONTRACTOR <br />y <br />et"Pile-a-- iid ..e .4/e Al&er Arel <br />ADDRESS LICE PHONE