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• USAN JOAQUIN COUNTY PUBLIC HEALTH SER,.A ENVIRONMENTAL HEALTH DIVISION P.Q BOX 388, 304 EAST WEBER AVENUE; STOCKTON. CA 95201388 0031 488.342a NON-REMNOASLE PERMIT APPUIC/ITO/I tt ✓✓HIERF SY MADE TO THE SAN JOAOUIN COUNTY FON A PEMW TO M ALL THE WORE(MGCMM-THIS APPLICATION IS MADE IN COMPLIANCE WITH 6AI, JOAO"COUNTY DEVELOPMENT TI04 LL APTER 9-1116.3 AND T16 STANDARDS OF SAN JOAOIAN COUNTY RMX HEALTH SERVICES.ENVIRONMENTAL HEALTH DMmcN. JOS ADDRESSIGR APPS 2 - 0 2- 13 - /� n err, _ T� c y PARCEL stzFJAPNP Z,3F-D2--L3 OWNSI 7 NCa-, bAOOIESS 3600 u.►K � A-of., cu. PHONE CD.NACTon AOOE6 on P Ne s� . Sfia _� c�riT �- tIC/ PHONE*- 43`(-9100 MRS CONTRACTOR 6 y-ea Ar:��: �.� p G51e) ADDRESS 1 Sa �owc P� K�„ „irz LicS y 13151 b S hpHE P TYPE o1`wlEueLHRNRP' ❑ NEw WELL ❑ Po%Acomwr WELL ❑ MONrrowNo WELL• ❑ oTMER ❑ NSTALLATNON ❑v L mrrm REPAIR ❑a1DG6 coma T REPAIR ❑ VAPOR cmwwrm WELL I fTYPE OF PUMP) ❑N.w❑p pw M.P. DEPTH PUMP GEr Pr. FIRST WATER LEVEL O ❑ DUROFMRVICE WELL ❑0"PHYMCAL WELL 0 ❑ SOIL SOM M ElveormucraDN: M W-`tA , m W- s .I✓l W- +F,,l�,-z3. Ca,-a j WTGM M Usf TYPE OF wELL CONSTRUCTION 6PECIRCATROMS A 0 tIIDUSf1EIIL ❑OPEN sorroM DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR GISMO 0 ❑OOMESTICJPISVATE ❑GRAVSL PACK/SIZE TYPE OF CAST SISTEPLAOM Dol OF WELL CASINO D ❑PIJSLICARINKWAL ❑OIEVEN DEPTH OF ORDNT MAL SPECIPWATION >t ❑ISSOATKTWAG ❑OT/IE11 GROUT SEAL INSTALLED BY SPIRIT SRAM NAME p ❑mawronsm amour SEAL PUMPED: ❑V. ❑H. CONCRETE PEDESTAL BY DRILLER❑Y. ❑No S APPROX.SOTN LOCKING CNERER S07USTOVE PIPE a /`11000600,cei we MET m MUD ROTARY AIR RorARv ALIOER CAGLF oTHat I/EKY CERTIFY THAT I HAVE PREPARED THSG APPLICATION AND THAT THE MSIR WILL SE DONE IN ACCORDANCE MGIH SAN JOAOUII COUNTY OMMALACES.RATE LAWS.AND RULES ANO REIAATIONS OF THE SAN JOAOLNN COUNTY. NOW OWNER OR LICBMW AGENT'S SIGNATURE CERTNES THE POUVWNq:'I CMTWV THAT IN THE PERFORMANCE OF THE WORK FORT VAECII THIS PEMW M ISSUED,1 SMALL NOT EMPLOY PERSONS SUIIJE TO WORKMAN'S COMPOWATNON LAMS OF CAUWIMA.- CONTRACTORR S/RENO ON SUI.CONTR=r0M SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIPV THAT M THE PER POIMMNCE OF THE WORK FOR WOW THS PEM1ITr to IMJED.1 SHALL EMPLOY PERGOLAS OLILACr To WORKMAWS COMPENSATION LAWS OF CAg1`O1MA.' 71�7ANT T CALL K MOWS N1 ADVANCE POR ALL 111601.11111110,INSOWTIONS AT MM 441101-24112. COMPLETE DRAWING AT LOWER AREA PROVIDED. Opd X TRM r(,0?c - fila,..-o-' 'v D.a PLOT PLAN prow to snow w. It-- I. 1. NAMED OF SHEETS OR ROADS NNEARIM TO OR SOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED I. OUTLINE OF THE PROPERTY.OMNG DMMNMONS ANO NORTH DNFCTON. EXPANOW OF SEWAGE DISPOSAL SYSTEMS. J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTIM AND PPIDPOSED S. LOCATION OF WELLS WTTHIN RADIUS OF ONE HUNDRED FIFTY FT. --t I UES.INC LUOIIO COVOEED ALFAS SUCH AS PATIOS,OW41WAVIL AND WALKS. ON THE PROPERTY OR ADJOINING PRORMY. -••--.... .. - - -- ... .. .. .. .. ......... - ----------- :..... MAP ON BACK :. ................... .................................... ............. ...... ....... ................................................. ................................. DEPARTMOWT USE ONLY APi...n A...Nd sY0,.0 //-g 1'b M.. O..wa M.P..II.n sr - Or. Pur-Nn.—Lon h Dan. D..wWn trw.." Dr. I - . cower ft. ACCOUNRNIG ONLY, AIDI FACS PS COOK PER IRO AMOUNT RNYGr m CHEC'miCASN RGOisvm SY OATS PeflAffSSIr.1m R[OI$ST NurAm INVOICE Z �Oo �3 //- -9G d10 gam/ 7 WpZ{� HVOE:e 9661-SZ-6