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APPLICATION FOR WELLIPUMP PERMIT SAN,IOAO11IN COUNTY PUBLIC HEALTH SERVICES` ENVIRONMENTAL HEALTH DIVISION `�11 P.O.BOX 388,304 EAST WEBER AVENUE,STOMON,CA 95201388 (2091469-3420 9011 REWU nABLE PERMIt EI(PUIES 1 YEAH FROM DATE ISSUED (CDInplefe In 11IPRe4011 ArPLICATION IS HERE BY MARC TO 111E RAN JOAOMN COUMY FOn A rT.nlAlt in CON MuCT ANRMn iNSTM L IIfF WOW nFSCofl`BP.1108 APPLICATION IS MAGE N COMPLIANCE Wllll SAN JOAOUPI COUPOY DEVELOI'MEMTITLE. APTER 9.1116.3 ANO Tot STANDARDS OP RAN JOAOIJIN COIIFRY'1'1101JC M..ALT If SERVICERO R,FNVINI,IEMAL IIF.AtTII OMPION. i JOA ADDREPS/OR'AP'//II��-� y J�?/ Al/l •,rj/, Fit'! {l PAIMF.L SNF./APNI Z OWWW"NAME nnnnrsa�7 (�/ G�c//JG• /�-p/J(J PHONE I . � CONTMCtOR iSC{LCZ/1tY�/�l7�t✓//7'✓Ayi�/1 nnnnFP� ��—��— ��/y..A aVR coNrlacron /L1 b'%'LL� tTr r/�"V/L,�S� /I�<< ARnNFBe 3 oY.?�rF�r.�4y LIc 5 /6 nroNE , wet—It ..�� -- -- . TYPE OF WFLLMUMP• ❑REtLACF.MAIT WELL rIL---IYlMOMIOnINR—Lt I/ ❑Di1rR _ _ - ❑INRTAtLATION ❑WFtt RVRIEM IrrA1n 1-J CMOS-CoNNFCf MrA1a ❑VAPOR EXTRACTION WELL/ / R VPE Or P1MPI - ❑N.w❑nM.h II.P, nEM/I MY—RET R, finST WATER LEVEL O ❑OUT-Or titoviCE WELL ❑aEOPIVRICAI.WELL I IJ FOR ROIRNn i� S ❑DEAtnuc TION: INIENbED RE TrPE OF WELL CONRtPVC110N lVECIFICAiIONAo ❑INDUSTRIAL j ❑OPEN BOTTOMDM OF WFI1.EXCAVATION DIA.OF CONDUCTOR CAftafa n E�1-y-1 nowtimPEOIVAIC r❑r-y1 nMVF.L PACK/SITE 1VIY DP I:AnINRIRfErIR'VC `'DL,�L+ P.A.Or WFL1.CASINO PIMLIC/MVNICa'AL 1-.1 DRIVEN Omit or nlout SEAT. PI'FCIfICATION R T❑�OMMAIKIN/AO ❑OTHER Onnot aFAL 11/St AlIM RV MIR�y OBRAND NAME G•'r.' E JCI MOMI01PN0 n1101N FFAI,FIIMrFD:O Vw. I.EN„ / CONCRETE rt1IF.RTAL RV OM1.LFn:I3 V,w lgn S A—.X.OMIT tOTnf 11IO CIIEPITP PDXIMOVF.AEF ✓ s 1'ROPOAtO CONRTRuenON/dtlLNNO MFTNRO:MIMMTA"Y A1RIIOtARr AIInFR—{/ CAPLF. OTHER I IrRFRY CFn"THAT I IIAVE Pr,PAT1E1)TIOP APPLICATION AM THAT 111E WDA(Will.OF RDW..N ACCORDANCE N/Ilit BAN JOADUN COUNT ORoINANCEB.RTATF.IAWR,ANO PIVLFS AIM ' Brain ATIaNa Or TIIF PAN JOA01101 COUNTY,HOME OWNER OR I.ICTNSIn AOT"T'R RInNAfUrF CF Ia1FS 111E rOt1OWMD:'I CFMIrY MAT IN TIFF PERTORMANCE Or TIIF Was(Toff mecii Ties PERMIT I0191VFO,IANALL NOT EMPLOY PERPONa RM1JECT1OWOnKMAN'4 COMPFNRATION EAWO Or CAIIrOMA.•COMRACTOn'RIORINOOn PVS.CON,RAC1NOGONATUMCEMarR 111E TOLLnWMa: •1 CfMNY THAT PI TIPE TEfrO MANGE Or it Wo"K TOR WIfICII 11115 PERMT IS 18AUF.0,1 SHALL EMPLOY Pf RPONB SUBJECT TO WORKMAN'S COMMIIRATION LAWS OF CAI.rOON1�1 A Ap//ry�P�ANT' f C IPPR N AnVANCE rOn ALL PFOIXnrn INIP{FC11OONN4 AT Jf R 4400.U. 22-COMPLETE PFAWINO AT LOWER AREA PIOVIDFfL al.—I% i.. IIP. LCA/F'I1. o<� BLOT PLAN In—1.9n0.I M.I. I. - 1.NAMES or tRaF.ETB On ROADS NEAnEPT 10 on POUNnato lir PPIOPt PTY. - 4.LOCATION OF IIoVaE REWAne IN.M At BYMtM On F OIMREO !.OITTLINE OF TIIF POOMMY.Of VINO DIMENSIONS AND NIO OM/1 O1REClN. F.XPANs10N OF BEWAaE 018M AL RYBIFMB. ' i 3.DIMENSIONED OtfltPMa AND tMATION OF ALL EXIMMO ANn PnoMpra R.IDCAtMN OF—tic WRIIIN MnMe OF DNF.IttMOMDTr1Y R. BIRVCTVREP,INCLUDING COVERED AREAE RVCiI AS PATIOS,DRIVEWAYS.AND WALKS. ON T/IE rmpunrY On ADJOINING PIOfERTY. - AnrrpmMtmt vee ONtr 9�']]� _ APPRe.11,0 ee '_Or /y {� _ D.I. � � V I M.. mem L,.r.e,len or Pon rv„P In.n..n.n RE nn.lr1e11.n Imn..lien Pr DN. Wc)ry, QILi� Wlod f r:., n ursl�a•� S -- A-- a✓ll.Q L or r WPB oet� 5 A.Lc"N NANO ONLI AIDE FACT _ PE coots TEE INTO AMOUNT REMITTED CHECKI/CARPI _PFCDVEn nY DATE PETWIT/8MVICE REOUEEf NtAMBFA INVOICE r ►41 11— — lub.Health Serv.-IEnviro.173(3/96)