Laserfiche WebLink
DzoB�z� <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)46&3420 <br /> #011-REFUDDARLE PERMIT EXPIRES 1 YEAR IF 4010 DATE ISSUED <br /> lGlylld In TIyRSAUI <br /> AM ICATION RI IiERE EY MADS TO TRE ENI JOAQUIN COUNTY FOR A PEANUT TO CONSTRUCT NMATR NITALL THE WOK DESCRIBED.TICS APFI.ICATION IN MADE IN COAIPUANCE WrIH SAN <br /> PAE <br /> JOAQUIN COUNTY OCWLOEHF TITLE,CHAPTER 9-1115.3 AM THE STANDN NbS OF SAN JOAOUCOUNTY FIM-C HEALTH 111MACEI,ENVIRONMENTAL HEALTH CIVISION. <br /> JOB AOGRIS,SRIR AwIP, 9 2 1 6 W. Lorraine R d. CITY Tracy PARCEL SQEPAMY <br /> OKrgA 0 NAME, R p l I y 5 n 1 a r i 0 AD(MEDI S 1 A FNG1l,835-6972 <br /> CONTRACTOR Freitas Electric[ Inc. A fIP.O.Bx16 Banta ixj53962 835-2814 <br /> — PHONE 01 <br /> M CONTRACTOR AOCMSS UCS ~HES <br /> rvPE OF WU4Jp+1_. Cl NEw Wtu ❑wriLNeEA na WEILL ❑MONITORING WELL 11 ❑OTHER— <br /> [I NKAtLATbN ❑INQEfYSTSAEIEPAN CIcRaKS-corKxcT �1 11VAFDIIlk'fMCT10N L <br /> Sub ❑N-E3FIAFA, R,•. 314 DEMNP SET 71rb FIRST WATER LEM <br /> ' o <br /> TYR OF p[NAPI <br /> ❑OUT-OF SENOCE WFLL ❑OEOTNYDICAL WELL/ ❑ SOS.RORONO f <br /> ❑OEKNUCTIOFI- <br /> NT CONST UCT10K A!tEnCARONA A <br /> ❑(HOUSTRIM ❑OPEN SOTTOM DIA.OF WELL EXCAVATION OU,OF CONDUCTOR CAINO O <br /> fw-1OONg SrICArOVATE ❑GRAVEL PACK/MF TVpF OF CASRIGISILYLJPVC IAA.OF MIL CASINO O <br /> ❑WSlI MUNICPAL ❑DIfVEN DEPTH OF OROVT DEAL _ V*-VFICAYIOH R <br /> ❑DIRIGATION/AO ❑OTHER OAOUT SEAL NTTAUM BY Orour EawD NAME F <br /> ❑k0ow, aNOOFbUT SEAL PJUKD,❑Vw fJ w cONCREre PEDESTAL fY Ownw,❑Y- ❑Tb s <br /> 100 <br /> 0 0 <br /> AFV"CX.OWTN LOCIUEIO CHESTER SOXIKOK RAPE 5 <br /> PROM20 CONSTRUCTIONMA LIlNO NOTING& MUG ROTARY AIR AOl ARY AUGER CAKE OTHER <br /> 1 HEWN CERTIFY TWAT T HAVE PREPARED THIS APPLICATION ANO THAT 1W WONT(WILL BE DONE N ACCORIAN:E WTII SAN JOACIL N COUNTY OIOINAPCEt.STATE LAVH.AM RULES AND <br /> INEOVLTIO <br /> ANS OF THE SAN JOAOVIN COUNTY.NOME OWNER OR LICENSEO AGENT'S SIONATUHE CERTYIES TIE FOLLOWING:'i CERTIFY THAT IN TLE PERFORMANCE OF THE WORK FOR VASCH <br /> T MS PEFMT M ISSUEO.1 SHALL NOF tAIM1OY PERSONS IUJECT TO WOMMAWN C--OVATION LAWS OF CALSIOFISA.'COMRAC?OR'E NIINIO OR 11)6COMRMTDIO MGNATURE CETG IF1FS <br /> THE fOLLOWINO'. '1 CERTIFY 1007 MTHE PETEONAAAW1 OF TIE WOM FOR WHICH TMS PERKT IS ISSUE%I MALL ET. WY PERSONS SUBJECT TO WORIOMAN'S COMP9ISATION LAWS OF <br /> CAIXOFNIA.' TITS Y T CALL N NOW 1 AITVANCI FOR ALL MGU1Rm NSPICTEONS AT f7'Jf/4MJ6I3.COUR-M ORLWTNO AT LOWER AREA PQROOVIOEO.[� Q� <br /> Sw./X _ v TIM. r - D.S <br /> FEOT RAN RI,W h Ie ,]Sen• Rs <br /> 1.NAMES Of STREETS OR ROOM NEAREST TO OR WtRUDfNI THE PMRRTY. S.LOCATION OF/ROUSE SEWAGE 0101 00^1.SYSTFM OR PROPOSED <br /> 1.OUTIfd OF TEE PRORMY,GAV 0 DIMENSIONS AND NORTH DNECTION. EXPANSION OF SEWAGE DpPOSAE SYRTEMS. <br /> J. DVAtNrOFRD OUTUIFS AND LOCATION OF ALL EROSTI,G AHD PROSOSEO S.LOCATION OF WELLS WITlNH RAOMS OF ONE EKINdEO FIFTY III. <br /> STRUCTURES,INCLUDING COVERED AREAS QKN AS FATIOC DRIVEWAYS,AM WALKI. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> Aw <br /> •-•.- ; .. <br /> t� <br /> PAYM ENI <br /> AUG 21 1998 <br /> sm""V'0014 Wow', <br /> PUBLIC HEALTH SERVICES <br /> E <br /> NVIRONMENTAL HcALTH O1V191()1• <br /> gpIIRTMBR USI oERT <br /> AF01,N0,.A,A,FRFF IV_ <br /> O.r.IrueTYn In,FFalbn Sv I DNS <br /> AeeelnrrnIO.NLre AIO/ FACS <br /> P[CODFA FEE FFR. AMOUNT IM.ITTEO NECK ASH KC BVEO Sr DATE P*SATABRNCIIRRA/!G^UE/T N NNI'm IM'OKE <br /> 15'21 <br /> -1 CO I VW <br /> PVG '-t 3m Serv.-Em o,173(1107) <br />