Laserfiche WebLink
5-12-1998 7:3SAP,1 FRO P- 2 <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBIJC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)463-WO <br /> NON EFUNO B p ftff EXPIRES 1_.ytAl FIgyA OA7 I8 SUED, <br /> ;O <br /> "PLICATION IS HER!1Ty MADE TO THE am JOAMM COUNTY FOR A PEFvxT TO CONSTf <br /> CONSTRUCT ANDASR INSTALL THE wow oEBCRISED.rt"APsLtCATJON to MAbE w COMPUAWT WRII SAN <br /> JOAOUIN COUNTY OEVELOPMi;wr TITLI*..CHARTER 9-11115.3 AND TILE STANDARDS OF SAN JOAOUW COUNTY PUBLIC WALT"SlRVIOEs.ENVIRONMENTAL HEALTH OIVISRDN- <br /> JOS AODAESO/OR All., !- <br /> 7 CITY 'f ♦ PARCltE4FJAPNI-�aC ��J�1G-14 <br /> OWRRER'O NAME - _-- r `� ..„„ -- AbVft'._S_i 5 W.7'{,;f s_ T�lri/�F/1_ 3 <br /> n r 7 <br /> CONTRACTOR 7 ADORERS I �1 P,',)E �D I '•a(,� UC1 0 0 q i M,ONE. I LS !} <br /> ave CONI"RACTOR <br /> ADW148t_--,_-..... `I/ �l!Yi PHONE-• /VA <br /> TYPE OF wEwpurAr, 3 ►mow WELL X13 t1 PLACEMENr WELL 0 MONrroroND wE3m ff oT+KEVI �Y•`._ <br /> u INETALrAQ T1ON WE'LL UYSTEM REPAIR Q CROG&CONNECT MPAIR Q vAPpry EXTRIAC€TON owtl, <br /> (TYPE OF PIlM!'R <br /> Q N..r©mw N.P. DEPTH PLAAP SET__ LV <br /> �R7. mw WATER LEL_ TI <br /> �'i <br /> ttGGff Q OUT-0F SERVICE WE'LL CI OECPHv*cAl.WELL R� ❑ .O0.0014Na E <br /> MMffrRVCTION: . -I- - <br /> INrENOED Uli PE OF WELL �0�3s7RucrlON aPECtF�.AIIRi A <br /> Q INOVSTPOAt 0Optw corroM VIA.Of WEU,ExcAvATtvN &A.OF CONDUCTOR CASINO p <br /> Q DOMESTICIPR IVATE 0 GRAVEL PAc%rsQz TYPE OF CA%IKOmTtrLIPvc GIA.OF WELL cAINNO O <br /> Q PUEIJCIT.R mpPAL ©DNIVEN DEPTH OF smut SEAL � OFECIFICATION R <br /> Q LrtSGATvwAG ❑OTHER EROUr IM MIOTALUED*-�Y -- - ,_-- GROUT RRANO NAME E <br /> I3 MONITOmm 09 � GROUT SEAL PUMPFat oYw 0N. CONIC”PEDESTAL BY&PULLET-Qv q Ow S <br /> APPRox OEFTH M W- / W-�- M -3 /9 L01*m CHEUTER sox/Srove PARE S <br /> PROMBIM CONSTRVOTIONIDI,CUM METHOD: MUD ROTARV AIR ROTARY AUGER _CMS€.-.._.__..�,_OTHER <br /> I NEvEBY CERTIFY THAT I HAVC PREPARED TWO APPLICATION AND THAT THE WWW WU UE BONE TH ACCORDANCE VAIN BAN JOAOWN COON rl OMMANCES.STATE LAWS.AMC MAN AND <br /> 11EOVLATIONO OF THE SAN JOAOtRN COUNTY. HOME OWNER OR LICENSED AOENT"S EIONATURE CUWWWC THE FOLLOWING;-1 CETiT'IfV THAT IN THF PwOR MAWE Of THE WORM POR WHICH <br /> THIS PERMIT M ISSUED,I SMALL NOT EMPLOY FEREONe SVBJFCT TO WORKMAN'S COMPENSATION LAWS OF CALIFOP*EA.- CONTRACTOR'S W4W OR M)6-CONTRACJmO wouATWIE CER "U <br /> THE FOLLOWING: 'I CEITrrFY TRAY M THE PERPORMANCE OF TME VVON(FOR WWCH TIRE PP}SARr If►SLUED,1 SHALL EMPLpY PSTSONE SUB.IEC7 TO wd11p{OAN'O CdhLP77V�Ar1OM I.AVW M <br /> CALIFOPMA.' tHE APPueANT MUST CALL til HOUa Of ADVANCE FOR ALL REQUIRED IREP¢TW W6 AT tMl Aft4M(�X-- COgMPLE"DRAWMO AT WwEH AREA"40VRDEa.. 4 <br /> RIO+rd X TIM. v C. Y / <br /> FL.dt PLM,IO•Mw H 110-41 Slow •T ^ <br /> T. NAMES OF STREET!OR ROAD!WARERT TO OR OOVNDR40 THE PRDPERTY, s. LOCATION OF HOUSC SEWAGE DISPOSAL SV.,EM OR PROPOSEb <br /> t, OUTLINE OF TNF PROPERPV,OIUMO DIMENRFONB AND MOAT"OFMCTTON. EXPANSION OF ffWAGE DISPOSAL SVETEMtl. <br /> E. bRMENeIONEO OUTNNFS ANP LOCATM Of ALL tXWFMG AND PROPOSED S. LOCATION Of VVEL LS WITTRN RAMS OF ONE HUNOTIEO FIFTY PT, <br /> STRUCTURES,INCLt MO COVERED AIWAS 7X"AS PATIOS,MvtwwvC AND WALKS. ON THE ayHOPtNiY LIR ADJO1MN0 PROPEP", <br /> y... .. . <br /> DEPARTMENT U■C ONLY <br /> /v.. �°P <br /> 0-4-A, peatieft Sy D.l.���A�riP Ken BT' VnE <br /> Deletueli.n b>rvwlSlon BT �- <br /> D.t. <br /> Cew.werh.: -- <br /> ACGOUNTMe**L T! AMP FACE <br /> FE COD" FEE rNFv AMOLIW R@ATTFa Cfi ASN RECEnm IT a TE Pgrar€eTwytDE RFQmT NUmRm IlryprCJ <br /> Pub.Heath Sery.-EnAro.173{1/87) <br />