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11-05-1997 1 :5SPM FROM P 2 <br /> 'APPLICATION FOR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> SOX-REFU1f0ABLE PERIUT ExPIRES I YEAR FROM DATE ISSUED <br /> APPLICATION IS RIPE DY MAOI TO SHE DAN JDAOM COUNTY FOR A DETART 70 lCospi�d ft Trip5art+1 <br /> JOwOVIN COUNTY OEVEIODYFM TTRf.CHAPTER 9-T 115 3 ANO THE STANOARDSCONSTRUCT JOAWW COUNrY PUBLIC HEALTH�SERVICFD,ENVRONAIENrAL AiJ.T O Len".ANCE WRII SAN <br /> 2 � c NbLLTN DIVIEIDN. <br /> Joe AOORESRJOR ARI. ll�D ' U CIT.., G - /v PARCEL 8QTJAPN. <br /> Owwwo NAME /� /W Ao�su"/ <br /> ./ ACNE S10 8 405- <br /> 090000*,�/ ��LLl.Z! AODIIEBS_ O.,(�OX a0/Z '��"[oe4 <br /> +� �6pI.oNE. / es-z-6262 <br /> 600 CONTRACTOR AOORfR UC' + <br /> =OF Vvtl•VFtJARn ❑ New wEtt Q REPLACEMENT WELL XMONrrORtfsl0 Wal ❑ OTTIER <br /> ❑ MSTAUATRON ❑ WELL SYSTEM REPAIR ❑CR06&CONMCT REPA11% ❑ VAPOR EXTRACTION WEU I 1 <br /> ❑NNr❑Repulr <br /> (TYPE OF PUMP)) H.➢- OEPTH TAP PUqu FT, FLRDT WATER Lf VEL O <br /> ------�—�- <br /> ❑OUT4FSERNCE WEU ElOEOPMYmAL VVELL 0 0 DOLL no, No � <br /> ❑DEfTTRUCT1pN: <br /> INTENDED USE TYPE OF WELL CONATAUCTNIN Sp TIONS A <br /> T( <br /> ❑INfDIlRTIaAL ❑QPEN SOTTONA VIA.OF 1ti1Eil EXCAVATION 01A.Of CONOt1C7DR CARRIO C <br /> ❑ OOMEST1CIRaVATE Zl-- %TL PACKINZE TYPE OF CAMN"TfEUPVC_ OIA,OF WLLi CASINO 071 D <br /> ❑ PueUCAMM CMAL ❑oM/EN OEOTH OF GROUT DEAL SPECIFICATION ,F <br /> 1El IRWOATIONIAG Q OTHER GROUT REAL INSTALLED BY GROUT BRAND NAOIE <br /> X,tR MONrtOtaNG ( GROUT DEAL PUMPED!OY— On. COW-Rem PEDESTAL UY Z)PwL ER❑Y.. ❑Ne S <br /> A""OR.DOTH 75- LoacPic CHESTER soxisTDvE PIPE S <br /> PROPOSED CONSTMCTtONlDIR.IJNO MUS400: &WO ROTARY AM ROTARY AXXM OTHER <br /> I FkE t 'I'CERTIFY THAT T MAW I'll"AOMD TMD APPLICATION AND THAT THE WOW WILT.BE GORE IN ACCORDANCE WITH SAN JOAOLRN COVNTY ORDINANCEO.STATE LAWS,AND RULER ANO <br /> ItEGUtATONS OF THE DAN JOAOUOI COUNTY. HONE OWNER OR LICENSED AGENT'S SIGNATLRIE.CERTIFIES THE FOIJ,OININQ:'1 CERTIFY THAT M THE P AMMAANCE OF THE TAONi FOR WHICH <br /> THIS PERMIT IS MUM I SHALL NOT EMKOY PERSONS RVEJECT TO MbRKMANY COMPENSATION LAWS OF CALW*MaA.'CONTRACTOR'S HyRNO OR RUB-CONTRACTOM SIGNATURE CERrsTES <br /> THE FOLLOVANO_ 'f CERTIFY THAT IN TTIE PEAPOICAANCE OF THE WOR(FOR MAACN TISS PERAMT R f0a11EO,t SKULL 0-toy po=vo SUBJECT TO WOMDAAIPS COP&MMILATIOM LAMM Of <br /> CALIPONNiA.' T A71TM CALL 24 RO%XW IN ADVANCS POR ALL RpaMCD IMSPIVI:Igo AT QOy 40iI$!, COMPLETE OM7MN6 AT TOWER AREA PROVIDED, <br /> 9tOrwd]C TAN %�T� �p� Vin._ ��� —/ ✓ <br /> ROT PVAtt 0.~to 9e.W Y.Y. N <br /> 1. NAAAES OF STREETS OR ROADS NEATEST TO OR OOUNORM THE r'ROPERTY- 4. LOCATION OF MUSE SEWAGE DISPOSAL SYSTEM OR 0140MSED <br /> 2. OUTLDIE OP THE PROPERTY.GWINO OIMENR U"AIA NORTNI DIRECTION. 0MAYSION OF SEWAGE OMMOAL STVrEIAS. <br /> 3. DIMENSIONED Ot7TLMFS ANO LOCATION OF ALL fKTSTMIU AMD PROPOSED S- LOCATION OF MW UA MIITTAN RADIUS OF ONE HUIONED CIPTY FT. <br /> STRUCTVRES.WCLVOtMO COVERED ATE"SUCH AS PATIOS.OR MIWAYS,AND WALKS. ON THE PPOPERRTY OR ADJOINING PROPERTY, <br /> rz AcN <br /> DWARTMINT USS OMT <br /> fyvut Ir..eeeneo SY D+I. fll.11p LnpooOsn ST Dat. <br /> O.t. <br /> O..t..�+bn Y.e.ellsn <br /> By <br /> AJh v <br /> ACCOUNTINO ONLY: A]Of FAC/ <br /> Q COC" FEE INFO AMOUNT REWTT ED CHWKSICASH RECEIVED SY OAS< pT1OUstlSERVICE REOVEST NtRimcm INYO/CI <br /> PUD.Health S0fv,-EmiTD.173(1197) <br />