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IN <br /> #APPLICATION FOR WELL/PUMP PER'''T <br /> JOAQUIN COUNTY PUBLIC HEALTH L J 9VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NON-REFUNDASEE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> AFY•LICATRON 19"HIE Sy MADE TO TIIE SAN JOA OVIN COVNtV FOR A <br /> JOAOVIN COUNTY DEVELOPMENT TITLE.CHAPFEq I ICONSTRUCT 1q MINOR ORINST <br /> ALL THE <br /> 1116.3 ANO TIIE STANIDARDS OSAN JOAOV N COVNry ry1pLIC [�LTII B[IINICEB,HIS APONMENUI S MADELTH IN COIGN. <br /> JOB ADDRESS,,AryJI O/7K Ayr TOMENTA IS MATH OI COMPLIANCE WNN SAN <br /> OWNEn'8 NAME N 1:�• Lr. C,C S CITY 1 IBJ/l7 A,'q `TS <br /> '4 (` <opARCFL OIE/A Z(0 1 <br /> CONTRACTOR ADDNES, Bo" / AN _ Q ): INI '3Jd–..j <br /> Vo a G+Ct�JD <br /> —�❑❑ r 1'IA�M_1Y-_A�—Y-b-i?ll r�'✓ - T5A7I <br /> ��C�•9rn <br /> �✓54 <br /> C•. — <br /> P5H�'–OINCB�E <br /> .T, <br /> r3 _Svqmpun CONTRACTOR wAnbnra@/ VFZ: y TL <br /> �5UCI 2sCm nADDnm 313 n11, 7o <br /> TYPE OF WLLprdpf14 S1N(pI 3S"••-l_3 <br /> 2NNWEL 0 IEPLCEMEFLL MOND ORINO WTqEALI ..NTWMON"❑WFM nPAIR FTJ OTHER <br /> AyPF�OFUMpI� ❑Nw❑Inndr H.P. � CIOOO-CONNECT nfPANrJr <br /> 7' <br /> C(3n <br /> DH`TN pU'p',T— . VAroELn EXTRACTION WELL <br /> P-, LJ OVT.OF SERVICE WELL FIRST WATER LEV <br /> r-1 bFgTnGDTIONv OEOMIypICAL WFIL I d <br /> "Olt"onINO <br /> INTENDED"UIE <br /> IYPEO WE <br /> ❑ INbV81R1A1 ❑OPEN BOTTOM CON/TRUCII_ SN_'SpECIF�C tI 'No <br /> ❑ VVMEPTIC/MIVATE DIA.OF WELL EXCAVATION 1 O r <br /> Fy 0F�TDRIVEN PACK/SIZE Nom'– /�� DIA.OFCONnUCTOn CAgglO A <br /> LI ry/pLICIMUNICIRAI IJ DRIVEN TypF OF GPINO/a TEFI/PVC , <br /> ❑ IRRIOATIONMO OEpf 11 OF GROIR 6F.AL DIA.OF WFII CASINO /V D <br /> ❑OTHER 61TCIFMATION N /� O <br /> ❑ MONITOnINO OROVT OVAL INOTAHED By 1-,1'2' <br /> "�T LJ---��I OROVi GRAND NAM a <br /> APPROX.pfptH Z X OROVT REAL pVMITD:ay. <br /> CONCRETE fTDEgTAl 9Y ONllfR❑ym Ay Ne r F <br /> ry10POIED CONBgUCRONIDINWNO M LGCXING CIIEatEn aO%/STOVE rypF /L%/.Q, q <br /> METHOD! MVD ROTARY }� <br /> AM VOTARY AUGER S <br /> I IIEREOy CERTIFY THAT 1 IIgvE pnEPAISEO T1119 A CABLE OTHER <br /> REGULATIONS OF TIIE SAN JOAOVIN COVNtY, HOME OAWNFn ONi1 lIOENSFO A M'p p10NAi VRE CfNTDIFO TIIE IOLLOWI <br /> THE PEnMK M ! f 1 OIIAI IK LVILL RE DONE IN ACCOIIOANCF WITH BAN JOAOUIN COUNTY OMINANCF.O,STATE TAWS,AND Ott <br /> THE FOLLOWINfeeT EMAOV PFggONq SUS.IfCT TO WOgXMAMY COMPETrQT10N UWe OF A IfOgNIA. p,n E11TIFy THAT IN TII <br /> 0: ' RTIFY T N TIIE PERfORMAN(: C L E PFNORMAIICE OF TIIE WO lEa Allp <br /> CAIIfORN1A.' TIIE A CA W T E OF TIIE WORK FOR WIIICII THIO RACTOR'q HIVING Oq OUl �FOn WIRCII <br /> LL t1 Ib1A\I IM ADVANCE FOA A PFRMN IP ISIVFb,1 IIIALL EMPLOY I'EnSONa SUBJECT TO WOgXMA <br /> CTI SIONATVRE C,RTu,, <br /> LL REOUgED INIPECRONI At 1Tpq A�IJAI1. COMIgEtE bMWI N'I COMPENRATION <br /> �,/ NO MLOWEn AREA UWB OF <br /> bfb�. <br /> VrYk l 4P a TIOT ICU N<d•w n M:�pe.l. D.1.�--`1 <br /> 1. NAMFN OF aTHEETS OR IIOAbS NfAIIEgT TO OR POI/NbINR TNF 1'l101'ERTY <br /> t. <br /> OUTLINE OF THE TE10lT •le <br /> ], bIMlNOIONEO OVFINE�ND LOCATIONorAll 1X1aT11NG AND IAgppgFb � LOCATION OF HOUSE$BADE"IOIq•AL ayntm On M10 <br /> S TnUCtVntp,INCLUDING COVERED AREAE BVCII AS PATIOS,D FROM,,,AND yyAUa EXPANSION OF SFWAOE b16TOpAL SYSTEMS, I'OSEb <br /> S. LOCATION OF WFLLq WRION"blue OF ONE HUNDRED MFTy Fr. <br /> S'r � <br /> 7'v Q 2.F Yr Q: SETY�' <br /> — 11 ON TIIE fVOFERTy On ADJOINNO rROpERTy. <br /> I I <br /> I.. <br /> y <br /> I 1 : 1 •• I i <br /> i <br /> /.... .o._..> ._> ... <br /> > <br /> DEPMTMENI VSE ONLY <br /> Annlleepnn AeerolM Ry O n <br /> OrelA Impmgen BY b•1• " 2--c-' <br /> A 7 <br /> bwgnnllen I,Hnmllen RY D•la hmv 1nrPmllen qY �T� Iq <br /> OW <br /> emmbN•: D•1• <br /> ACCOUNTING ONLY: AID/ <br /> FAP <br /> PE CODES FEE INTO AMOVNT"WITTER EC MAIN RECEIVED By <br /> GC �� DATE <br /> ts PEIpOT/SERVICE REOUEIT NUMBER <br /> O 1 Ca <br /> INVOICE <br /> ��7 5 <br /> b.HeAlth SOW.-EnyirO. 173(1/97) _ <br />