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„r <br /> APP ICATION FOR IAAUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE. ST'OC'KTON, CA <br /> (m) 486342a :3r4 Floor <br /> NOWREFUNDAYLE PEANUT <br /> APPUCATION M HEfIE BY MADE TO THE CAN JOAOUM COUIVFY FOR A PERMIT TO CONBTRUC'T AIOIOR WffALL THE WORK DEACRIRED.TM APPLICATION M MADE IN COMPJANCf WITH BAN <br /> JOAOVIN COUNTY DEVELOPMENT TrTIE,CC APM a-1 11 f”SAND T X 6TANDAMG OFA VAN JOAQUIN <br /> JOAQUIN CDVNTY PMLI'C�H{EA�L,TH GERVECM E11VNIONMENTAI HEALTH LX%RV*N. <br /> JOB ADOREBSOR APIC_ I , nw •\' `c-1-(N 1-L A V ti CT' I��y��^•�'i Rn p PMCEs1L B2E/AAN, q� ^, <br /> OWND"NAPE �yjTN�2 L?k-N 11 CC� ADDIIEBA ` 1 -/ 1-L)L�-rrf � Oh V-L�7NDPHONE j,7 Io- ? `3-CJ <br /> co-\st,( fc—t s <br /> c _DAMES 1�-_LA oaf F_ ADORxc� - Z I M X41 N :5T uc, rr1"ONE 1.4'��/-''9b-sem <br /> SMS CONTRAM <br /> CTOR 1 KI)N[: _ AtHMK�2� 1( ' ,�. S� LICJ oS 727 <br /> TYPE of wFl.t/PUI.IP• ❑ NEW WELL ❑ REPLACEMENT VAU ❑ aw"MMM4 wEu F ❑ OTHER <br /> ❑ l/BTALIATON ❑ W[LL SYSTEM REPAIR ❑ CTORB•CVNNECT RLPMR ❑ VAPOR EXTRACTION WFU F ✓ <br /> ❑M.-El A wh H.P, Deri'm RJI.R BET FT. FWIST WATER LEVEL - O <br /> TTY9E OF PUYPI <br /> ❑ OUT-014WKVCE WELL ❑ GEOPHYSICAL WELL F J�r BorL 1,01a NO g <br /> ❑DESTRUCTION: <br /> INTFNDm IME CONiUTIO ■.iP%CAO ■K (L <br /> /1 <br /> ❑ WmUSTRIAL ❑OPEN vorroM DIA.OF WELL EXCAVATION DIA_OF CONDUCTOR CASINO D <br /> ❑ DOWATIC.1MVATE ❑OPtAVEL PACKMIZE TYPE OF CA9INOI6TFFLMVC IIA.OF WELL.CABIf10 D <br /> ❑ PUSUC'JMVMCIPAL ❑DRIVEN DEPTH OF GIIDVT BSAL SPECWICATON R <br /> ❑ rmoATIDNIAO ❑OTHER GROUT REAL INSTALLED BY OOOUT UA."M NAME <br /> E <br /> ❑ LfONTT010No GROUT SEAL PUfMED: ❑Y_ ❑hlo CONCRETE PLDRSSTAL SI'D'uUXJh❑Yw O N. s <br /> ADMIX DfPTM I LOCK)NO CHE3TEA SOXlTTDVE PIPE //�•� pp �^ S <br /> R <br /> POPOSW COITSTITIJC'T1OIHldVLUrG METHOD: MUD ROTARY AM ROTARY AUOEA CABLE OTHER 1= <br /> 1 HE'WBY CETTTMY THAT 1 HAVE PREPARED THM AFflJCATKIN AND THAT THE WORK WILL SE DONE W ACCOMANCE WITH BAN JOAOJIN COUfITY Of:DWANCFR-STATE LJLWF•ANO MILEV AND <br /> REGULATIONS OF THE rAN JOAOUIN COOLINTY, HOME OWNER OR UCENUR:D AAENT'S SKINATUI(E CERTATES THE FOLLOWINO! T CERTIW THAT IN THE PCWomAANCE OF THE V o W FOR WHICH <br /> THM P WIT IB ISSUED,1 SHALL NOT EMPLOY PLTIBONB SUBJECT TO WORIIWAN-a COsm"N&AT1ON LAWS OF CALIFMMA&' COFJTRACTOR'S WWNO OR BURCONTRACTINO MNATVnE CLRTTFIEE <br /> THE EOUAW Psa: '1 CERTIFY THAT M THE PFMORMANCE OF THE WORC FOR WHICJ7 THEA FTTGArT IS IBBULD,1 SHALL EMPLOY PCROONB BVB.JELT TO WORIOAAN't COM►DMATION L AWY OF <br /> CAUFOPPGA" THE ADPIICANT MUST CALL 9t M ADVANCE FOR ALL R11OLNUM YIVECTIIIIOOM AT MOO)�=. C�OMfJL�ETI<�DAANAAINO AT LOWUA AREA PRO VID <br /> BIO-d X Tb. C I (��U I( 3--X V st D.t. <br /> PLOT RAN 0—b Be.l.) <br /> 1. NA IES OF OR ROADG NEAMST TO OR 1I0LPNOR40 THE PROPERTY. 4, LOCATION DF HOUR£REWA+OE DIOPOAAL TIYVTFII on moPo6tD <br /> Z. OUTUIIF XM THE"%GPCTTTY.O1V*M DOA[W'OOND AND NORTH Din£CTION. rKPANAgN OF VEWAOE DISMgAL BYNTLIAB. <br /> 7. DRMFWMONM OLJTLINFG AND LOCATION OF ALL EXIVTIN0 AND PROPOBED i. LOCATION OF WELLS WITHIN RADIUS OF ONE KUNO;rD FIFTY FT.' <br /> grYWCTVR1'6.MCL.UDIND COVETED AREAS OUCH AS PATIO$,DWVEWAYA-AND WALKD. ON THF PRDPVTTY On ADJOIMNO r'ROPUTTY. <br /> — __ <br /> 1 .. <br /> r <br /> : : . MAP aN BACK ... <br /> ......... r.:: <br /> .. <br /> ............. ................... ...T...... <br /> .. .. <br /> DZIPAIRMBfT Ulf oNLTr <br /> A00-Ti.. C�1 C �l C 1 A00-Ti..Aero.p.rd U1' p�� LV 0.M 7 r� l \ M— <br /> XIrwI n..o.ocl..r By D.I. ro. 0_0.00.II By D.I. <br /> - <br /> �� (YL <br /> Commr.ur, V✓�- �LI��. <br /> ACCO VIlT/R0 <br /> ONLY-. AIDE FACE <br /> PE COD" FLE rNFO ANOINT RZIAQTTIM CHPCKII'CASH RLZQVtm SY DATE P90LET/SbIvfCE RLGUCST NtVM" INVDICF <br /> �X"A 1 C 1 a` a-�o.5"v <br />