Laserfiche WebLink
*PPLICATION FGR WE,-I'_/PUMP PERMI• � <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES G �s <br /> ENVIRONMENTAL HEALTH DNISI <br /> 304 EAST WEBER AVENUE, STOCKTON A 9 02 <br /> (209) 468-3420 <br /> IION-AFfUN0A6LE PF.AMIT F%PIRES 1 TEAK FROM GATE ISSUEDT,'�m DESCRIBES- <br /> _ ILamOMb Ia itEl,c/bI _ <br /> APPIJCAT ION IS I'EM BY MADE TO THE SAN JOAOUIN COUNTY FORA PERMIT TO SOOF SAH JOAQUIN CO NTY BUC•NSTRUCT H/EALTH SERVIC£6i Eus HN IRO MEWAL HEALTH CATION's MADEIOMf+�-- <br /> JOAOUIH COUHFY OEVELOFMEHT TFT PT <br /> •CHAER 8-1116')AND THE 6TANA"'I j ink JUN IC <br /> PMEL BCFIAFN/ <br /> JOB ADDRESSOR AFTII /E r-% AAg1OHE l <br /> OWFIER'e NAM nI F� CpAJ TaBR.;51 5'j6 46x2 a,. PHONE lse �b <br /> WE�em��E�jerru L;� �/ l�t� �aCcufuEsc.f�tA+ ADDRESS eA ev _ems 0781 oA.PI �� <br /> A � . 1/• � � .n..__ ., Pn ADD^Eitys —'^'� d 4 r L1C/cS7• 768/ PfeoNE/707- QJ3• <br /> BUB CONTAACTOR IPS �SS11 !-I <br /> .•, J bl MOHRONNQ WELL! C OTNO1 <br /> T`YPf OP wftIM1MP: ®®I Nf'M WEl1 ❑ PERKFMENT WELL J VARJR EXTRACTION WELL/ <br /> C MBTAUiATgN ❑ WELL BYSTEM A"A"' C CROBBCONNECT 11EPAIR NRBT WATER LEVEL <br /> / <br /> OEM"PUMP GET FT. <br /> N/�.' GNw+GR.Pw H.v. <br /> !�I r7 sok Somme <br /> TYPE OF RIMPI � J OVT-0FBERVICE WELL OEOPHY6ICAL WELL l <br /> ❑OEMUCT10N <br /> TTPf Of WF31 INSTRUCTION 'PECICAVA ICA IIOM• /J �y / /'/ <br /> OM CIA.OF WELL F%LAVATI <br /> INTENDED VGE F CONDUCTOR CASINO <br /> ❑ <br /> INDUSTRIAL OPEN BOTTON—� DIA.O <br /> / / TYPE OF CASINO/STEEIIi'VC �CJIp'4' WA-OF WELL CASING <br /> ❑ OOMEBTICRHSV ATF ®OMVEL PACKRIRE SEM /%' SPECIFICATION <br /> C MBUC/MUNICIPAL G DEPTH Of GROUT DmVEN - /e,• OPOUT BRAND NAME 4/PZ I— <br /> �.'•'^ T'Ut <br /> C I.OATIONIAO C OTHER GROUT SEAL INET ALLEU 9Y J7� r� <br /> GROUT SEAL NMPFO: <br /> Ys ❑Ne CONCRETE PEDESTAL 9Y OWLLER:td Y. ❑Ho <br /> MONITORING <br /> LOC%IND CHF6TE0 BOA/SOVF PPE <br /> wvvnG A.GEP1H AVG EP CABLE OTHER <br /> PROPO6F0 CON6TTVCTIONIDmLUHO METF100: MUO ROTARV <br /> AIR AUTARY <br /> NE:N ACCOPOANCE'MTN 8AN KAIX11N COUNTY OR:IINANCF6.STATE UW6. '.NO 0.ULE5 A <br /> I HE^EBY CERTIF HAT 1 HAVE PREPARED TH18 AIRICATION ANO THAT IN GEW'S SIG ADO - N{MCFDIYB HIM"DR bLBCONTMCTINO 610NATUPE CEFR,F <br /> REGUUTION9 Of:NE'SAH JOAQUIN COVNTI'. HOME OWNER OR UCFH6EO AOEM'S SIGNATURE CERTIFIES THE fOLLOM'INO:'I CERTIFY TEAT IN THE PERFORN RACNCE IN THE FATUWOW SDR w <br /> THIS PEPART 1818NW.I HALL EMPLOY PE11tDHB B,WECT TO WORWAN'e COMPQI[AT10M LAWS <br /> THIS PETIMIT IB F T6 e,I SMALL NOT EMPLOY. HomeB SUBJECT LI WORKMAN•'COMPELI'ATION LAW OF CAMMMH . <br /> THE FULL NO: I CERTFY THA IN TIE PERFORMANCE OF THE WORK FOR WMCN WFIG AT LOWER AREA P,VNOE7 <br /> ,,(G T CALL S NO B IN ADVANCE FOR ALL REONRED I^fRCTOM�T ISOFI.d�2]. CONiI_•TE ORA <br /> CAUfORN1AI• THF APeVCA }r � 14- <br /> L- <br /> ea.»a z J <br /> I.—PLOT PLJ{N IDre+l le B•WI 6c^. {- LOCAI%1N OFHOUSE SEWAGE pI8PO8AL 8V8TFM OR"A"MSED <br /> EXPANSION OF SEWAOf DISPOSAL SYSTEMS' <br /> 1. NAMES OF 9TiK.c a OR ROAOB NEAREST TO O0.BOUNDING THE pigPERTY. RADIUS OF ONE HUNDRED F,FTY FT. <br /> Z. OUTLINE OF TNF i ommV,GMNG 01WHISIONB AND HORTH 01PECTIOH. S. LOCATION OF WELLS WTaH <br /> N OF ALL F 111140,ANO PROMISED ON THE WIOPEIRY OR ADJOINING PRENTY <br /> OP . <br /> 2. DIMENSIONED OUTLINES ANO LOCATro <br /> STRUCTURES.INCLUDWO COVERED AREAS SUCH AB PATIOS.pmVEY/AYS.AIO WAIXS- <br /> PrP �f� cLc� e �C- , Z/3B <br /> - <br /> .......__. <br /> -- — <br /> OFDMTMENT USE ONLY <br /> At— <br /> APWIe.,bn AiN,.I- 5T 0.1. <br /> D•1• Aare wesEen BY <br /> O.au,I.wesellee 3r <br /> On• <br /> BF <br /> FAG, <br /> LACCOUNTING My <br /> R COOFI FEE INFO AMOUNT REMITTED I I GATE <br /> tUAWITRPRVICE REQUEST NW90 I INVOICE <br /> CHECASMASH ECOVM SY <br /> I ZaG1 I4 0� r I Zl'jLl <br /> I i I <br /> I I I <br />