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6APPLICATION FOR WEWPUMP PERM <br /> 8AN JOAQUIN COUNTY PUBLIC HEALTH SER& <br /> ENYHIONMENTAL HEALTH OIVISION <br /> P 0 BOX 388, 445 L SAN JOAMIN ST., STOMON, ca dMSWENTAL HEALTH <br /> (209) 468-M0 PERMIT SERVICE <br /> MMIFUUbABLE PE Uff EXPIRES 1 YEAR FsA■_DATE ISSUM NOV 16 PH 4122 <br /> { GI Tri mcm) <br /> APPLICATION 18 HFRF BY MADE TO THE SAN JOAMI N COUNTY FOR A PEMM TO CONBTMMT AMMR DISTALL Tiff WORK OFA.THM APPLICATION 03 MADE W COMMA NCE WITH BAN <br /> JOAOUW COLINTv DEVELOPMENT TTI L L CHAPCIE, 9-1118.3 AND T#w BTA mms OF SAN JOAauw COUNTY PUBuc mrALTH covvrEB.ENVIRONMENTAL FSALTH amwo . <br /> JOS ADO R APNJ. ��L,�S 71p14} 3+5 S Nay y Dr. CRY .�C tv PARCEL GMAFKf �r/� <br /> OWNER 6 N/1YE �a`Lie7 f 'a(el C+1 /��I 1 AODIVW � BW 4V25 RIOM1 I W 1V[- <br /> CONTFIACTO "1 C Envie i��/MM I ADDRESS ��ff��, /!!`���,]�,.�,y. �+^��f <br /> SUBCONTRACTOR ✓f?� [d'y�(71/1`1 _ A www I�NIlGho Krel� Llcr Cs (OD,'27 . SL'`�T <br /> ra3--ccwar 13NaW Wiu 17 mn^cawEwr WELL 13 ewNnaPU m waL r arl <br /> 17 mmALLAnoN 13 WELL SYSTEM REPAST 1 3 CA08S•CONNFC'T REPAIR VAPOR E]CTFW.TmN WELL r J <br /> CI Naw 0 Rma H.P. DEFTH PUMP BET FT. FMT WATER le M a <br /> FM OF PUlk9n A y� <br /> 0 our4w-mvm WELL D mmnwBCAL WELL/ 80a BDTm�Ea -2-6 -f F 1✓� s <br /> 13 DEaTRucrwN: <br /> OF MMI& akSTRUMMM� TIONS r/ A <br /> 0 g OUSTMAL D OPEN BOTTOM OUB OF WELL EXCAVATION f+/� DSA.OF CONDUCTOR CABIM�/ D <br /> D OOlamcoPW VATE D GRAVEL PACICIBZZE_ TYPE OF CABIIYflIBTEEI./PVC, - NGL. O+A oP WELL CA$IlTfi IV D <br /> D Pummm1INl wAL D MVEN DEPTH OF GROUT SEAL BAECffCATION R <br /> 13 mRaATIONIAG D OTHM GROUT SEAL INSTALLED BY GF9DUr BRAND NAME F <br /> D motwo a C� / GROUT mAL mmu ED: D Y. D No CONCRETE PEDEBrAL BY wnLm D v.�./❑N. s <br /> APPRO,DEPTH L✓ LOCKING CHWM BOXWOVE P[P8�._ 4 1 Ec+ <br /> PROPOSED CONBTRLM'TIONIl1RIU=METHOD: MUD ROTARY AIR ROTARY AUGER <br /> T�tl�rvrad'I.t �+� <br /> I KMZY CERTIFY THAT 1 HAVE PREPARED TMS AMUCAT03N AND THAT TPG:WORK WILL BE ON MOORDANCE VAIN BAN JOAGIAN COUMMOROLMANCES.STATE LAWS,AND FOR AND <br /> REGULATIONS OP THE SAN JOAOM N COUNTY. HOMM UWN4ER OR UCEN SL90 AGEENT'B 6KNNATURE CERTUM9 THE F011O MNG:9 CEATOY THAT IN THE PERFORMAN $OF THE WORK FOR WK CH <br /> THIS PERROT IS ISSUED,I MALL NOT EMPLOY PERSONS sumMT TO WOmVAN s COMPBmA71OR LAWS OF R 9 HEING OR 6U&4ONTRACT1PJG SIGNATURE COMIE$ <br /> THE FOUMN2 -. •I CERMY THAT IN THE PERFORMANII:E OF Tm viom FOR wHtCH Txm PETIIOT I8 t881NE0 ! rTjr QOMPEIISATNIA LAWS OF <br /> GWFD ANT Z4110ltILB pi AOi/ANOH FOR ALL h'8I� NS AT _�/�� <br /> PLAT PLAN mrwr m eabl lm.le •m �� ��� ��vV �/� f r�ai� <br /> 1. NAMES OP BTAEETe ap RDAOs NEAREST TO OR FUNDING THE PROPERTY. OR PROPOSED <br /> 2. OUTL�DP THE PROPERTY,GIVING NEB AND NORTH DAN. �]}/ i <br /> 9.STRUMM.HNCLUDING COVERED AREAS SUCH AB PATM8 DmEwAYvs.AND wALKS, b FITTY FT. <br /> 1� .. & . <br /> ...pv1.. . .. <br /> _ .. <br /> 5Eel . . .: <br /> . <br /> J DEPARTRMET LM ONLY <br /> A A-mpUd Date . ®I�/[AP oI <br /> Gant kapaooian BY Dae Pumy Irespmtlon By, Dat. . <br /> Oestrntlan G.gf.atl0.�Pq awe- <br /> Conti No <br /> �tNa ON1Y: Air FAC! <br /> PH C'OOES PEE Dwo AMOUNT RvwgTTE0 O=- J MOVED BY DATE PERMiT16ERVICH IOQUFBT DIVam <br /> O I <br />