Laserfiche WebLink
. 111'"wnulF rvn'FFELL4rulNr rcnmu <br /> "1'B✓! Ijoq/C - -- <br /> SAN JOAOUIN COUMVUBLic REALTH SERV'"• <br /> ENVIRONMENTAL HEALTH DIVISION .k ' <br /> 9D4 EAST WEBER AVEdJUE STOCKMK CA <br /> 1209) 48"= sr-4 FLOOD 4 <br /> -NON-REFUNDABLE PERMIT <br /> APPLICATION M HERE WMADE TO THE SAN AADUHN COUNTY FDR A PERMIT TO �1CONSTRUCT AH,,OR SOTALL THE WORK OESCMSED.'THIS APPLICATION Is MADE W COMPLIANCE WITH BAN <br /> JOAQUIN COUHTy DEVELOPMENT TITM CHAPTER 8-111G5.r.3 AND <br /> THE STANDARDS OF <br /> )S <br /> ANK.,oACLM CPtO/U�NoTwY PUBNC HATHy,W"iCES <br /> ENVIRONMENTAL <br /> THEALTH <br /> HgIO <br /> VNESO2!N4. <br /> OS AGORESA0UR APMZ 70/ Gne CRY PArcEI WMAPHr <br /> OWNER•t NAME — �" . yb� <br /> /3�-)�0v, V2'7-�5/seifaADDREae <br /> eoNrnAcro / � ", ,_PHDME <br /> ADDIE86tCr <br /> SUS CONTRACTOR .. , ADDRESS PHOW <br /> R(4is1 45 C"9476 <br /> TYPE OF WEL:JMP- ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MOMTOWNO WElLr ® OTHER - <br /> E3IO <br /> NSTALLATN ❑ WELL SYSTEM REPAIR L3cnwt MEcr REPAIR / ❑ VAPOR_ETTTMCTON WELL <br /> r .T <br /> ❑NFw❑RgYr N.P. DEPTH PLIMPSET�FT. `/\ EL p <br /> RVPE OF HUMPHFIRST WATER LEV <br /> , <br /> ❑ OVFO"ERVICE WELL ❑ GEOPHYSICAL WELL r OA-)S/Trz S <br /> ❑DESTRUCTION: L.VJ 7-0 OFF$/fi <br /> IMTBIOED ME TYPE OF WILL COWTRLICMN SPEC1gCAMMS <br /> W <br /> ❑ SISTItlK ❑OPEN BOTTOM DIA.OF WELL EXCAVATION DM.OF CONDUCTOR CASINO p - <br /> ❑ DOMESP <br /> TICIPVATE E3 GRAVEL PACK) TYPE OF CASBOISTEELIPVc DIA"OF WELL CABINS p <br /> ❑ bBL/CMUNICIPAL 13 DRIVEN DEPTH OF GROUT SEAL SPECIFICATION R <br /> ❑ PIRI ATON/AG ❑oTH1En GROUT SEAL INSTALLED BY GROUT GRAND NAME E <br /> 13 MOMTTOIIMp GROur sEAL PDAPED: ❑Y. ❑HH CONCRETE PEDESTALBy Onm ER:❑Y– ❑N. s <br /> APPROX.DEPTH. LOCKODI CHESTER SOIUSTOVE POE _ s <br /> CONSTINCTIONMRILLPIG METHOD. MUD ROTARY AOR ROTARY Y MOEp cAB1E OTHER <br /> PRObtFD <br /> Z., " <br /> 1 XEAEBv CERTIFY THAT 1 HAVE PREPARED T1S6 ATOM AND THAT THE VA M DONE N^COfnANCE WITH YA,JDADISN COLNRV ORDNAHCES.STATE LINT.AMD RULES AND <br /> REGULATIONS OF THE SAH JOAGUIN CODDY. OME OWNER OR LICENSED AO SKLNATURE CERTIFIES THE FOUDw Hb,-I CERDPY THAT W THE PWORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT IB ISSUED'I SHALL HOT EMPLOY PERbDH@ WLMCr TO WORSA AN•t COMPg10AMN UWB OF CALNDHISA• CONTRACTOR•8 NIPoNO OR BUDCONTRACTINO mpNATVRE CERTIFIES <br /> TM FOLLOWING: '1 CEIIT6Y THAT M THE PEWORLIANCE OF THE W01K POR WNICN TMS PEPAIT It 09M.1 SHALL EMPTY PERSONS SULUCr TD WONOHAN'S COMPESSADON LAWS OF <br /> CALIFORNIA.'�THHE APPJCANT MINT 2t NO N ADVANCE POR ALL IIEIXIa1I 'IMY/BIND"AT D/MH 48041421. COMPLETE ORA M AT LOWER AREA POND,,,. G G <br /> Sbn.S R <br /> PDT PAN IONRw•m BeHMI MIH •m <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPFNIY, A. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE MTHE PROPERTY.GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 3. DMENSONED OUTLINES AND LOCATION OF ALL EOCTM AND PMM ED L'LOCATION OF WELLS WITHIN RADIUS OF ONE HUNOIED FIFTY FT: <br /> 6igUCTVq,S,DHCU101NG COVETED AREAE SUCH AS PATIOS.DSVEWAYS.APA WALKS. - ON THE PROPERTY OR ADJOINING PROPERTY. <br /> . ..... <br /> MAP 4N BACK <br /> . <br /> . SET" S."fcy p �s GfIGO�inlr//C <br /> ` DEPARTMENT ME ONLY <br /> APFP..Lbn A.. IT <br /> 0.I.P.t=..BT--- Plum hFP d. IAP Ow. <br /> Osfncel.n R".o .SY Gm . <br /> �..: aFf hln ; rot gsc �ntEs - c, 2 v• ta OJL4 <br /> ACCOUNTING ONLY: AIDI FAG <br /> PE CODFA FEE INFO AMOUNT RTARITED CHOV"ICASH RgGVEO IAP DATE PGIAT/2HIMCE NEOUNLT NIMRER INVOICE 1 <br /> b 1 , o .n ,� I ` <br /> i <br /> z d z _ ��_ f � woaa wdze�z 8661-1Z—zI <br />