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..uw•ncru..uAblc rcn..__ J-,_ ICompAb rin�lrpiie+tt),— .. APPLICATION 16 IIf RT RY MAOI.10 111E FAN JOAOUIN COUNTY#011 A PRMIT f(1 CONSTRUCI AN011/11NS f At TTI(wOm Dr SCMBt D.THIS AP11K AI FUN I8 MADE IN COMPLIANCE WITH SAN I' JOAOUIN COUNTY DFVf IOPMAENI TIT" "APTFFI9 111 5.3 AND THt£TANOARI).OE AN JOADUFF,COUNTY PUBLIC Hral TH SERVICES.ENV"IONAIt NTAL WEALTH DIVISION. a JOB ADURFSS.OR IAPNN ) 1 - 1 1-_4Lf CITU \ ^ I 1 PARClL�!S'AfM• OWNFR'8 NAM( AIMRFRR r�1! \ NN)NE CUNTMCfOP I 1 l (/. �- !i.i ADINVs � I l�LK. "CL ," P`10=14 '-1 SUB C0;4TfUC10R -pont 6s Lics PHONE .I TYPE Cl m!UPUMP- ❑tit WS 11. Cl Af PTAf_EMf N7 WILL Cl E/<)NfTo PUNG WT LL P— ❑OTHER -, - ❑INSTALLATION ❑WII.I.SYSIfMMPAIR ❑CMQl CONNECT N PAIR ❑VAPOREXTRACTION WELL! J •> '�+( 7� ❑N-f7YJfw,a„ HP L DI P T F`"UMP sf T_FT. FIRST WATER LEVEL OW .N ❑OUT Of-6F RVICE VAI L ❑GlOPI/VSIC,AI WELL IFCl SOIL BORING R _ l ILI INTENDED USE { TYPE OF WELL CONSTRLICTION SPECIFICATIONS A ti ❑INDUSTRIAL El OPEN BOTTOM FLAK.OF WELL EXCAVATION XMA.OF CONDUCTOR CASING DOMF,TICR'NVATE ❑GRAVFI P.ACK;S4E TYPE OF CASI4G/3TEFL'PVC MA.OF WELL CASING r , Cl PUBLKRAUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL SPiCIFKATION IF ❑IRRIGATION/AG ❑OTHER GROUT SEAL INSTALLED BY GROW BRA/JO NAME f ❑ MONITORING GROUT SEAL PUMPED ❑Yw ❑Ne CONCNET!r'EDtSTAL BY DWI LER❑V. ❑No S ?1 APPROX.DEPTH LOCKING CHESTER BOXISTOVE AF'F S' PRO!OSW CONSTRVCTION/DRIL INO METHOD: MUD POTARV AIR ROTARY_—_�AIKfR CARIEOTHER.--— V4 1 HERESY CERTIFY T14AT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY O11DIN.NCF.S.STATE I AWS•AND MILES AND REGULATIONS OF THE SAN JOAOUIN COUNTY. HOME OWNEP OR LICENSED AGENT 6 SIGNATURE CERTIFIES THE FOLLOWING:'I CFGTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 16 ISSUED,I SHALL NOT FMPLOY PERSONS SUBJECT TO WORKMAN't COMPENSATION LAWS OF CALIFORNIA.-CONTRACTOR'S HIRING OR BUIKUNTRACTIN0064ATURE CEREIFAS ' THE FOLLONANO: ',I CERTIFY THAT IN THE PERFORMANOE OF THE WORK FOR WHICH'MI PERMrT IS ISSUED.1 SIIALL EMPLOY PERSONS SUBJECT TO WORIOMAR'1 COM/OISATIOR'LAWS SOOLFJF ,'/ CAf1F6REff; THS l�PPI CANT MUST CALL 24 HO IN ADVANC FMl ALL REOIXRED i 710Kf AT 12M1 NSIN2S COMPLETE OM'.Y.NO A7 LOWER AREA PITO LADED. --C/ e1trW XX�M i /� .1 ('� •� `rte TIER. 1 Li�y-+rir�-L.1 WI.� KOT IUM IDTµto SW.1 S"10 Tn_ 1. NAMES OF STREETS OR ROADS NE.ARFSST TO OR BOUNDING THE FTM)PEFTY. A. LOCAThOF SEWAGE SEWAGE DISPOSAL SYSTEM OR P1IDPoSED 2.OUTLINE OF THE PROPERTY,GIVING DIMENMNS AND NORTH(XPSCTION. EXPANSONIOh OF BELLS TMIN AD3AL SOF O6. T. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSFD S.LOCATION OF WELLS NRTHiN MdUS OF ONE NVNDRFD FIFTY FT. STRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVLWAYS,AND WALKS. - ON EHE PROPERTY OR AGJOININJ PROPf1RY. s� •r 171 Ax�1 .t DFPARTf.-LNl USE ONLY ..j /' Arr ! Appli-11on AxnPfed BY E -- / 1` A DF P-P In•pw[Ign By Orpul ln• -I,By -- Dal• �'!2 Dsnuntinn In•wwlt By _ - Commnu: I FACT ACCOUN17M0 ONLY: AID/ /[CODES AMOUNT REMITTED WI.,UASH RECEIVED BY DATE PO4AITKi/MCE REQUEST NV4Y 01 IrG/OICE s' •�1 '•x @I,