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APPLICATION FOR WELLIPUMP I fRMIT <br /> BAN JOAt1UIN COUNTY PUBLIC HEAL1I1 SERVICER <br /> ENVIRONMENTAL IIEALTII DIVISION <br /> P.O. BOX 388, SM BAST WEBER AVEHUB, STOCKTON, CA 982 -W <br /> 12061 488 3420 <br /> ki <br /> 104 RQUNVABL_ E PERMIT HPIRf! 1 YEAR FROM RATE I13VID <br /> 0 a, IComplrrb I+1 Tliptia1ltal <br /> APPUCAtION IS NFAE 9Y MADE TO TILE SAN JOADUIN COUNTY TOT{A PERMIT TO CONSTRUCT AN01011 INSTALL TIR WOW DESCIVREU THIS AMICATION IN MADE!N COMI'11A110E VVII11 SAN <br /> .IDACUIN COUNTY DEYELOrMEHT TTT1f,CIT ER& 1118 2 AND I It STANDARDS OF BAN JOAOUIN COUN Y PUBLIC HEALTH 9FRVICES,ENWROMMENIAL IIFALill DIVISION <br /> ,SIJ" 1 <br /> JOB AbOMON/OR PNB � CITY (�,} PARCEL 91;EIAPNB <br /> OWNfA tl NAME ^ APOREetl [ ()C Cj--] 14 tl ' MIONi 1'--a{l -a31 <br /> COIIIRACIO ADORES@ 7 / IICB� W TIIOIIE I�����C t� <br /> OUR CONTMCTOR �y AbonE88 LTCB MOM s _ <br /> 7YF[OF 4YFLUFUMPt �y NEW NRLL El REPLACEMENT WELL UU MONITOIIINO WELL I �-y}3 Y.-Jy4 OTNE <br /> ►.l ionmumotd ❑WELL SYSf EM nEPAtn ElCDO08 CONNECT REPAIR 1lW VAPOR EXTnACTION WELL A, J <br /> ❑H~❑Rep,lr II Im bEPTI{PUMP BEI-FT FIRST WATER LEVEL„`. O <br /> TTYPE of T'lll.RP► ❑-y ��--II ClovvT op SERVICE WELL W gEOMIYGICAL WELL B SOIL 9ORtN0 S <br /> C.f DEETnUCTtONJ <br /> T►-yy4L d O L T^� q CR O F CIT C ^-� 1 A <br /> INOU9Th1AL �❑OPEN moi TOLL bfA OF WELL EXCAVATION G VIA OF COMUCTOTI CASINO^ N 0 <br /> bT'N <br /> OME8TICIVATE UPJ GRAVEL PAC <br /> IU8ITETYPE Of CASINOISTEFLJrVC C,. DIA OF WELL CASINO <br /> ❑ PUSUCJIIfUNIOIPAt. I'mm OEPTII OF OnOUT SEAL SPECIFICATION L _ _ ____ A <br /> C3 InNOA110NIAG ❑Ot11En GROUT SEAL ITI9TALIED BY X11 OROUt OXAND NAME f <br /> 19 momoTVN0 j OROUT Sm rumpfut Q3 Y. ❑Ne COHCM2 FEDE9TAL SY TMU1n Ely.. ❑Ne S <br /> X DEBT11 Sc- LOCKtNO CIltsIin soXI9TOV£11PEIL� ,g,F`ti,}' S <br /> BED CONftfLPCTIQNMNLUN ETMO MUD ROIARY AIR hOTAnY AUGER^�_CASL1<_ _ _0111E11 _ <br /> 1 tts_,iY CtnTIFY THAT I HAVE T'REPAREO 11414 AMICATtON AND THAT TIIE wom HALL BE DONE IN ACCOTIAANCE WIM SAN JOAQUIN COUNV 0IIOINANCE9 STATE LAWS Alto TME4 AIID <br /> 11EOULJIIl0N9 6F TNF SAN J13AOUIN COUIiTY 110NIE OWNEn 13411ICENSEO A'3tM 9 SIONATUTIE CtMittlS TILE TOLLOWN01`i CETITiFY TTIAT IN T11E VITWORMANCE OF I NE woo Von WNICI? <br /> j THIS PEMAIT IB ISSUED,1 WALL NOT EMMOY PEnSON9 SUBJECT TO WORKMAN S COMPfNOAt4OH LAWS OF CALIFORNIA CONTnI cTOn S HIRING On 9US4CONTRAC TING 9tONATURE CEnuirme <br /> TIIE FOLLOTVIP1Gt '( ERTIFY TI IN THE PERTORMANC!OF THE WORK FOR WIItCN T1119 PERMIT IS ISSUED,I SHALL FMPLOY PERSON@ SVBJFCF TO WORKMAN S COMPLTISATION LAWS OF <br /> CALIF1. TN C HT OA E104M6 IN AOVANCI FOR ALL RE0UIn111 INItf "OHO AT I29p 48lJ4t1 COMPLETE DRAWING AT LOWER AREA flWV,OEO Jl <br /> Stoned X 7111• L AqL ____ DNB,_{)-Z Z C/ <br /> PLOT PLAN fDraw to SaWvj Seale I* <br /> - <br /> I NAMES O 81""11 On ROADII NEAREST TO OR BOUNDING TIIE PMPERTY 4 LOCATION OF HOUSE SEWAGE btSPVSAL SYSTEM on moPOSEb <br /> Z OUTLINE OF 111E PROPERTY,01VIN0 DIMEµ910HO ANDµ13fTTT1 WREC1tON EXPANSION OF 9EWAOE W03109AL SYSTEMS <br /> 7 OPAMPIoNED CUT UNF4 ANO LOCATION OF ALL EX16TIT40 AND rMP08ED 9 LOCATION OF WELL#WLTNIN RADIUS OF ONE IfUNOREO FIFTY FT <br /> SMUICTUREB,INCLUDING COVERED AREA9 9UCN AS PA1108,DIIIVEWAY9,AND WALKS ON THE R R01'ERTY On ADJOINING PRO1"EMY <br /> r J ► � J I t ' 1 t <br /> } <br /> i = A � t a ► � 4 J J ! { } � = i J � ! P j i i <br /> f � � t � � � � ► , } t t { f 1 <br /> i , _ �� � � t ► � { <br /> i ► t t i J I ► J <br /> { e q S 1 } f f <br /> i t f t ► i t <br /> Y <br /> } J <br /> t ` J <br /> } <br /> 7 r <br /> i 1 < <br /> t J <br /> _ t ► t f '� j � � _ s J <br /> t t ► t <br /> r <br /> t r <br /> n <br /> btrAnTMENT USE ONLY <br /> Apptteatlen AaeePlad BY Date Ar.a <br /> Oltrepeefien By _ , -Data Putnp lmi$,"Uen ST_ O.le <br /> glen Impeetlon By Dal• <br /> Centmenle <br /> ACGOUNIINO ONLY$ AID@ FAC! <br /> FS CODEIT FLE 114PO AMOUNT FUNITIiD Is 'CNEClt1'ICASll 71E06VI:O by DAIS 1'>3sM1T18tJtVlF!REOUIST NUMBER INVOICE <br /> , <br /> t <br />