Laserfiche WebLink
ENVINUNR)ENTALNEALTN'UITWiUO <br /> P 0 V-388, 446 N.SAN JOAMIN ST, STOCKTON,CA`101480 <br /> a= 488.3420 <br /> NOWNEFUNOAOLE PERMIT EXP= 1 YEAR FROM DATE ISSUED <br /> 10mapkis Is TriPbaw <br /> Application is here by made to the San Joaquin County for a permit to construct and/or install the work described. This application is <br /> made in compliance with San Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Public Health <br /> Services, Environmental Health Division. �/ / "(�, <br /> Job Address/or APN# `, _U)�T �/�S!/I W�'/'c�i1tY 'J L A t Parcel size/APNS / 1C Z� <br /> Owner's Nage ���'U� �C99 w�Ji��.,�� .�,r Address 9�pp,�J�3� W f'�4�M..Y�.i T Phone Nis 2 ��� <br /> Contractor ,+ e "Ax Address /O� A), 44 2 VA L i Phone nt� <br /> _ t <br /> �' <br /> c#•w� 7iD <br /> cam,. Phonwt X�� 7Ys^' 2'j <br /> Sub Contractor- i t c �..a9M Address��_ i;!r �'B6—k <br /> TYPE OF WELL/PUMP: U NEW WELL 0 REPLACEMENT WELL El MONITORING WELL N_ ~ Q OTHER <br /> KDESTRUCTION ❑ CUT-OF-SERVICE WELL [I GEOPHYSICAL WELL # p SOIL BORING <br /> [3 INSTALLATION E3 WELL SYSTEM REPAIR (I CROSSCONNECT REPAIR p VAPOR EXTRACTION WELL # <br /> O New 0 Repair M.P. DEPTH PUMP SET FT. FIRST WATER LEVEL IA zAwEr <br /> (TYPE OF PUMP) <br /> INTENDED USE TYPE OF INM CONSTRUC 11 SPECNICATIM y <br /> a INDUSTRIAL p OPEN BOTTOM DIA. OF WELL EXCAVATION gr� DIA. OF CONDUCTOR CASING a <br /> [I DOMESTIC/PRIVATE Xl GRAVEL PACK/SIZE TYPE OF CASIMG/STEEL/PVC JE J G DIA. OF WELL CASING <br /> (I PUBLIC/MUNICIPAL p DRIVEN S�04—DEPTH OF GROUT SEAL C/ SPECIFICATION <br /> 13 IRRIGATION/AG ❑ OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME ( 4 <br /> MONITORING GROUT SEAL PUMPED: U Yes p No CONCRETE PEDESTAL BY DRILLER: [] Yes [3 No <br /> APPROX.DEPTH LOCKING CHESTER BOX/STOVE PIPE 0x, <br /> PROPOSED CONSTRUCTIONiDRILLINO MMOD: NUD ROTARY_ AIR ROTARY_AUGER_ CABLE_ OTHER_ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, <br /> State Laws, and Rules and Regulations of the San Joaquin County. Now owner or Licensed agent's signature certifies the.following: "I <br /> certify that in the performance of the work for which this permit is issued, i shall not employ persons subject to WORKMAN'S COMPENSATION <br /> Laws of California." Contractor's hiring or sub-contracting signature certifies the following: " I certify that in the performance <br /> of the work for which this permit is issued, I shall employ persons subject to WORKMAN'S COMPENSATION Laws of California." THE APPLICANT <br /> MST CALL 24 HOURS IN ADVANCE FOR ALL RERUN WPECTIONI AT 0601 48"427. Complete drawing at lower areeaa provided. <br /> / .L <br /> Signed X (.C/(�C t✓ Title^✓?'r r C3Df��m1�/ Date <br /> PLOT PLAN (Draw to Scale) Scale_____" to <br /> 1. Nacres of streets or roods nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> 2. Outline of the property, giving dimensions and North direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned outlines and Location of all existing and proposed 5. Location of welts within radius of 150 ft. on <br /> structures, including covered areas such as patios, driveways, the property or adjoining property. <br /> and walks. <br /> WARTNENT USE OUT 4 Q re <br /> Application Accepted By Date ! Ansa l Y2 <br /> Grout 1. tion By Date Pump Inspection 8y Data <br /> Destruction Inspection By Date Comments: <br /> ACCONNT111 ONLY: I AID# FACO <br /> PE CODES FIEF INFO AMOUNT REMITTED CNECI[/ICASN NE VED BY DATE pawlsERVNO: REQUEST OMItER NORMCE <br /> p� d 500 -2'►v, 4-10-ls '29-V— <br />