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SAN JOAOUIH COUNTY PUBLIC HEALTH SERVICES <br /> EIWVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388, 304 CAST WEBER AVENUE,STOCKT(K CA 9'=1388 <br /> aOs) <br /> P"NIT <br /> A,P=ATR)N S HM BY MADE TO THE SAN JOAQUIN COUNrY FOR A PETMIT TO CONSTIWCT AW M INSTALL THE WOW OEBC"ISED.THM APPLICATION IS MADE IN COMMANCt VWTH 8AN <br /> JOAQUIN COUNTY DEMOPMEEN{T TfTLE.CHAPTER 9-1116-2 AM THE STANDARDS OF SAN JOAQUIN N COUN TTY PUBLIC HEALTH ISS,0"OISM6MAL HEALTH 4tW 41ON- {`7 Z <br /> JOS AOOAEa4AR ANN. 1 1 1 9 R 005 0-ve 5 L/� C, 5 f ocCl I_� PARCEL 69MA" Z <br /> ^�I J 1 , i <br /> OWNER'B r t Vg T i •e- G 0. --- _ADDI�SS E!1 l R a o i e U•01 l`. 5 Z - PitOPIE r 116 6 <br /> corirwscrat I1aV'QMC�A �joo xYiMaN1MIrN�Q ���c_, _AIIwMAO 3 W nIt""- LICr XX PIIDNtrj56�W <br /> ro�l Q ADDREas 3l� N; Rn �R4�4�!Y]LRc. $dam_sNtDNRE,�'y'�`l!'sls� <br /> sue coNrrRAcrDR �Y1 N t V'o,� -_ _ <br /> TYPE OT wmummP. ❑ NEW WTU ❑ IeruLCmaw waL ❑ moF7fromm w sA, ❑ c <br /> ❑ wsTALLATtON ©wzu uysTzM REPAIR ❑ CMS&COMNECT REPAIR ❑ VAPOR E aRA Tum wuL, ✓ <br /> 13 N-w❑R.p.d H.P. OEM PUMP SET FT. FIM WATER Lr%$EL - 0 <br /> (TYPE OF KPAPI <br /> © OUT4W-Cf WKX WELL L © QEOP1V=CA.L WELL L r SOr.DORSUM! S - <br /> 13 DEmwicTIOM` 'I <br /> t1ITENOED 11t[ ,T VM01�WELT. yJ A <br /> ❑ WDUSTRIAL ❑OPEN BoTTOM GIA.Of wELL rxCAvAToDN.___.x1 DIA.OF CONDUCTOR CASINO i D . <br /> ❑ D0MEFnCIPRIVAT1E LRIAVEL PACKMZE TYPE OP CAomwzr iow DRI,OF WELL CASINO D <br /> © PUEIXAWfWCVAL ©OWVEH DEPTH OP GFXKIT SEAL T D WVCWMATTON '- r - It <br /> 13 IRFROATIONIAG ❑OT"m cparr SEAN.Sdr.TALLM$Y anow www NAND orE <br /> 5 q 1.�r>K'��q <br /> 19 94ptSrorom r I ORpl►T SEAL FtAIPFB;❑Y« ®N. CONCRETE PEOESTAt BY DWLLEiC❑Y« ,N. S <br /> Ar?"oX.b�TFI ! 7 _ LOCXM/S C"ECTER EOXWOVE PIPE s <br /> MOPOOM MFrN D; MW FIOTARY AN ROTARY AUGER CABLE D 4 r.,ct eas <br /> I HEAM CERTIFY THAT I HAVE PAEPARW THM APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE VYITit am JOAQUIN COUNTY ORDWAHCEB,STATE MWS,AND RULES AND <br /> F*OULATXM Of TME 6Mi JOAOUMI COUNTY. 14094E OWNER OR LSCEUM AGENT'S SKWATURE CERTFFWS THE PRLLOWINW R CERTIFY THAT IN THE PERFOf"AOCE Of TM Vmw FOR VVHK:H <br /> TMS Pff"m 0ISSUED.1 A.ULL MOT DAPLDY po"oNe Wax=TO WOMOWIAWS CORP SATI N LAWS OF CAUFORMeA.- CONTRACTOR'S M R11M OR SU94MXTRACTINO MONATUtE CE mme <br /> THE FOLLOwIRMI: •I CERTTIFY THAT IN THE PERFOPJ.tANCE OP THE WORK POR VA*M Tips PEJ'KpT IS If8M,I SHALL EIAPLOY PEMONS SUBJECT TO WORIGAAWs MARfSMATION LAWS OF <br /> CALRPDWak- "ALTUCAPIT MlUIIT CALL 24 NOUNS IN ADVANCE FOR ALL P MIBFWCIWNS AT 0")44101 2. COMPLETE PRAVONO AT LOW IM AREA PW%ADED. <br /> S+Pn.ex ,��•�!irl. � TIu.. SoT�ior SId G5t D.R. IO-3l—�� <br /> PLOT FLAN 10r to 9od.1 S-6- ••to . <br /> t. tMMES OF 1TTRMT6 OR ROAD!NEMEST To OR souNomm THE PRopEwy. 4. LOCATTOH OF HOUSE SEWAGE 019POSAL sysr A OR PROPOSED <br /> 2. OUTLWE OF T'ME PROTEmT,Wvm DIM7ENSIONB AND NORTH Dtpwc TIoN- EXPANSION OF SEWAGE DISPOSAL SYETUM. <br /> 7. D"AlUSKMED OVnffAF.S AND LOCATION OF ALL ERIE TFIG AND PROPOSED E. LOCATION OF WELLS WTTIDN RAAIUB OF ONE HUNDAW FIFTY FT: <br /> BTRUCfUIIES,W=1004o COVERED AREAS SUCH As PATIOS,owotwAYs.Aim WALKS. ON THE PROPERTY OR ADJOINM PROPERTY. <br /> MAP ON BACK ......... .................. <br /> .............. ...... <br /> ........... <br /> ...........I............... <br /> ............. . ....... <br /> DEPARPNI0IT USE DEWY <br /> ATgNMbn Aomm"d By ' <br /> Went Nnob"Ion By Drew pu"w p.ctim ay <br /> o""wftn In.Tao" ay D.L. ' <br /> n <br /> AGt1OLSTTMa ONLY: ATO, fACr <br /> of COIN? PEE RAPD AMOUNT PdANTTID HEC m2covED sy OATE PWIISiK6tVtCE R[amt NI,YSBI pr4o CE <br />