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SAN JOAaUIN COUNTY PUBLIC HEATH SERVICES ENVIRONMENTAL HEALTH DIVISION. . P.O. BOX 3W 304 EAST R AVENUE+STOCKM CA Mm _._ IVSD - ry MR , APPLRCATRON IS KRIE BY MADE TO THE SAN JOAOM COUNTY FOR A Maw TO CONST7IIICT AmwR WSTALL THt WORK mod",TRCI AohmATRON 15 MADE IN CONTRA mm WrrH BAH JOAGUM COUNTY DEVaOPMENT TMJL CHAPTER D-1 115.3 AND TIS STANDAR)!OF EMI JOAOUM COUNTY PUBLIC HEALTH BERVICE6.ONWONEIEKTAL%MTN DMIIOH;J�. 005 5;.dva Nsua ` 1kbY) 17.0(?7F1p 700' V� r.f lVif�t PAXI JOBAODREBE/OR APH,7_ d .t... -- �( �ir�(/ �7 70C �0 PARCEL BMUAPW owrrFxa HAI*�,Y C 5�o[c /�a r i `�/�uL Aponres 3 'i M. 1. �r6-�y c�0 F :�{ ' -W61 COR�Tr1UCTOR AdUdKCt, y9o1:y,tAiy^Dn-vn-p y I�o 11 (- AbGRegg�1�03wl . Mcrc�i L'�- t,C,6$22—) PNONE. 6yfi-o�6t'1 Iu6aoNrRAcrOR�o; lS �X�7�oYd�i Oh_ Ss N U i[�4 f . ACCRESSi 1 393`/} fi r,jo Wo Lc, 5'%)j7 6 PHD>E,I goo g9�'7�7J ' aWr a av�ovd [ TYPE OP UREu.APump-, ❑ NEW WELL ❑REPLACER.lEHT WELL ❑ momToRSNo wm ❑ O ❑ AISTALLATRON ❑ W13L 8Yurm FIEPMi ©CRD cr REPAM ❑ VAPOR tXTRACnON WM 0' - J ❑tu.❑R.w6 H.P, 1 DEPT"PUMP BFT FT. FIRS'.WATER LEVEL O ITYP�OF r[II,+PI .- ❑ mror-seRvIcE we L 0 awmwmcu waL, ❑ FIDI.I omm a Ij�DEsrRSI,crRDN W - 2 M W-3,M K--y H w-5 M W n w-7, M w-q E W -1 III7BIR]�LIES T=cw wEm [!� DLA ❑ NfDImmm 0OPEN BOTTOM OIA.OF WELL EXCAVATION ! A.OF CONDUCTOR CASINO R ' 13DOMESTICfiWVATE M GRAVEL PAOUMM TYPE OF GASING S7 MJ`PVC DIA.OF WELL CA LNG a ❑ IveLlcnauNIcIPAI 1:1mvvm MI OF CROUT REAL .T_ y SPECIFICATION R ❑ SVIIGATIOHIAIA ❑owm GROUT SEAL INGTALLM BY OROLTT ErW.ID HALFE�GrT Uu_ _ �o Glt F(1, E ❑ MOWFOR G r .6ROUr REAL PUMaED: ❑Yr ❑Ne CONCRm PEDESTAL BY DRKLm❑Yr ❑Ha S APP"X.btPTR 5 V/'-7 LOCVJHB CHES, SOXISTOVF PIPE S PROPO*ED CONCTRUCTOKID01MUNO MVWKP-. MUD FIOTARY AIR ROTARY wUGER�x tA6lE OTIffR , I MFqIESY CERTIFY THAT T HAVE FRED 10 TI,"APPLICATION AND THAT TILE WORK WILL bE DONE IN AOCOrFOANCE vwrm SAN JOAOURI COUNTY OROMANCES,RTATF LAWS.AND MRPS ANb RHSIILATIO!!S OF TIE SAI JOAOVIN COUNTY. NOW OWNER OR LI 044 AOENT'S 800HATURE CEffrWo THE FOLLOV1AhlO:I CERTIFY THAT IN THE PERFORI/ANCE OF THE WORK FOR YVHPGH TMIS POUT 1E SIGHED,104ALL NOT EMPLOY PERIBONB SUF acl TO WOMMA YB C W113MA7'ION LAWS OF CALIFORMBA.' CONTRACTOR'S HWAM OR 81.154MMTRACTINO SYOHATURE CERrmt THE FOLLOWYPO: 'I CERTIFY?NAT IN THE PERFOMARCE OF THE WORK FOR WHICH TMS PEAMR IS 12MMV,I SHALL EMPUOY MWONB GUSJECT TO WORIOW"O COYPOMATION LAW!I OP c.At" &A,*.THE Ar,pLICwNT MLMT/CALL 24 HOLM IN ADVANCE FOR ALL RK+eaRtD Nalr[CTRO"AT 92001442-2623. COMPLET' . E1ORAWINO AT LOWER AREA PROVIDED. BINn.eX�= "•l 7�/'�f /"w(l�!_ 1- ThI. SPGtio✓ 5Ia�� lj¢o109;5I - -D.c. 4-19,' It7 PLAT PLAN Draw to Oc"Sado eo t. NAMES OF STFIWM CO R0008 HEA Ur TO OR BOUT401NO THE PROPIM". 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PFiDPO8 x. OLI LINE OF THE PROPERTY.OWING DOAMSIONB AND NOW"DIRECTION. .. EXPANSAM OF SEWAGE 098POM SYSrSM. 3_ b:lxFN oNM OUrL Nts Am LOCATION OF ALL EXISTRNG AND PROFOBEO .r 6. LOCATION OF mus WTi-M RADIUS OF ONE HUNDRED FIFTY PT: STRUCTURES,INCLU004 COVERFb AFMAS SUCH A8 PATIOS,ONVLWAYS,AID WALKS. ON SHE PFkOPERTT OR Ab"IH G PROPERTY. : MAP ON BACK �:.::: .. ............ ...... ........... ............. ............ ............ ............ ........... IIEPARIMidIT LIRE ONLY Arof4oHa,Aeaoled br Ornun Ion BF 0— Ibno wwPO."m NT Data D�unMn IN ap-of. ELT Coto c�' 1 • ,I ACCOUNT"m OFIM, ArW' P/1CI - ►E Carnes INFO AMOIIKT R RArrr D CHF KOOCASH RECOVEb OY bATt P6WStJi61VICE REOUEIT NUN IM INV'DI6i J a: .. - _._ .. - -- ._ __.,. - _Vats ._...- ..,•^,ti.i --':'L' -� - '�''`� --.-- -. - -_.-..�_�._ _. .. ..... .....�., .._ t-..