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S r r <br /> SAN JOAOUIH COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION # <br /> P.O. BOX 38Q 3Q4 EAST WEBER AVENUE,STOCKMIR CA 9201 X88 <br /> APPLICATION 16 HOE BY MADE TO THE SAN JOAOUBI COUNTY FOR A PEW.4TT TO TANSrAUCT AND=vwALL THE wom DtscmBw.TFSS APPUCATLON If MAGE W COMPLIANCE IIVITH BAN <br /> JOAOuw COUNTY DEVELOPP4M TITLE,CHAPTER 9-1116.3 AND THE stAHOAIOe OF BAW JOAOM COL*N PUBLIC HEALTH WVVICES.134VNROMAEHTAL HEALTH LIMMON. F . <br /> J �l�y'a <br /> JOB ADO14£'SaiOR APYer_ [v. 51 k{v'�'d- d d 1 Z• arr5 l o c � V1 P..:,,d o�rArHs J- a <br /> owHE7YtNAYF&?oo-yu Ngfvq 4/O Itoh 6rU40 Anpl�ss L436 W.. .-Marj05G{ v#.. 51I4y6llalg43 -530 <br /> coHrRAcrm )AAVaN C-td UP[) fFKV'ir0y-1 -ej4l (.•j jo(• ..Apmm 160) W- ucr 10 ;LPmw, I56 -0 <br /> SUS CONTRACroR5D <br /> '15 FX1 f oya 1 eta N1 5+N V i c.o 3 d 'Aaarl�sa 113$3-19 ti rI�a s W a �,5t�6,4 E PHONC iC Q5 x'73 77 <br /> vac 0 Lcp oVa 7D <br /> ' n Ly-4u NPU m ❑ ►rEw w6LL ❑ aIEPLAOEMEW Vvm. ❑ ►NvwrrotiMA WELL# ❑ OTHER ` <br /> ❑ RISTALLATION ❑ wELL SYSf9es REPMA L.a CTDSS440MECT RANI ❑ VAPMS EXTRACTION wEu• _ J <br /> ❑NwF{r❑R.pde H.P. DEPTH p1INP BET FT. FTRer wAT>g4 LEVEL. � � O <br /> ❑ OUr-0FiERvm wE L : ❑amweacAt wE L s ❑ BO4L BoRThla <br /> wwom IMF Tm OF WELL N Q A <br /> 13 M1ougmAL 0 om mor rom- WA.OF WELL EXCAVATION TI — DIA.OF CONEOCTOR CASING a - <br /> ❑ O0N.mwjmvATE - ®GRAVEL PACE TYPE OF c^momTEnAvc INA..OF WELL CASINO D <br /> ❑ PUCUC4AUNICIFAI ❑ORIVHI DEPTH OF GROUT SEAL T WVCDICATM - } - R <br /> ElMVUAnwuAa ❑OTHER pi UT GROPEAL LNUALM FJY „ OF"T BIWW HAEME Or UL( C o Iso4 K 1 E <br /> ❑ mowropwm .>. 'GFXYJT SEAL PUMPET):❑Y« ❑No CONCRETE PEDESTAL BY 0FI4LL h❑W4 ON. S <br /> A""".tmon" SO '7 5 1' LOCKING CMWM SOXMOVE PIP£ S. <br /> PWPOSM COMSTRUCTIONAX11U.M METHOD; MUD ROTARY Awl ROTARY AUGER CAME O e <br /> 1 HE4ESY CERTLFYY THAT I NAVE PREPARED THIS APPLICATNON AHO THAT TME VVOW VutLL BE DOM I4 ACCOPOANM WITH SAN JOA*M COUlC Y ORIMANCED,STATE LAWS,AHO fdRXS AND <br /> 1r MAT lows OF THF MAN JOAO(M COUNTY. NOW OWNER OR LCEKSM AGVNT'S SKM4ATUM CERTOM THE POtLOW+NO:'I CERTIFY THAT IN THE PERFOF"ANCE OF THE WOIK POR TYm c" ' <br /> TI48 PEIWIT IS ISSUED,I SHALL NOT EMPLOY PE116ONS SUBJECT TO WOIMONAN S COMP6aATTON LAWN OF CAUFOIMA.- CONTRACTOR-2 PIYmIO OR 64.154-,Op7R4CriN0 SMNATtM cENTIFIFF: <br /> THE FO LOwM4 ; •I CERTIFY THAT W THE PERFORMANCE OF THE w0FK FOR WHICH Tlap PEMMI>S ISSUED.I SHALL EMPLOY f 0mNS SUBJECT To WOMOAA1'S OOW01SATION LAWS OF <br /> CALIfORP A.- THE APPLICANT MUST CALL 24 <br /> 24 HOU S LN ADVANCE FOR ALL/IEdLM®DNPCCTION/AT RBS/4�21, COW-LM ORAMW AT LOVAM ATEA PROVOW. <br /> 5 f n i o r 5)cif'f <br /> PLOT PLAN LDerw m a."Se+.1. •,lot t <br /> T. NAMES OF STREEfs OR ROADS NEAREST TO OR DOW40M THE PROPERLY. _ 4. UMATION OF HOM SEWAGE pBPOSAL SYSTEM OR PPIOPOSIM � <br /> 2. OVTUME OF THE PFIOPW11.GIVING DWIENSIONS AND NORTH V"WC'TION. _ EXPANVMN OF SEWAGE DISPOSAL SYSTOn. <br /> 3. DOAFUSNONED OUTLINES AND LOCATION OF ALL LXWTRA APA PROPOSED a i. LOCATION OF WELLS WTTFMI MOWS OF ONE NVNWISD FIFTY FT. <br /> crRUCIURE .IFCLUOLNG CovFTEO ALFJIS SUCH AS PATIOS,OWVEWAYS,MID WALKS. ON THE PAOPERtY OR ACJO041M PROf"I I. <br /> _J._. ---- . -- --- - <br /> i <br /> , <br /> : : _.. MAP ON BACK ...... ............. <br /> ..:.....::.... <br /> ............. ...... ...... <br /> b"AlIT7ME NT ULE ONLY <br /> APOwepNFpFF Aee.plea SY ` pNa4 Ai1y <br /> 0'"Irso"tim er - Dame '' F%mw 6pocft <br /> Otw � wvmdm ST Dan <br /> t ACCOUNTNMO DHLY; AID# e .. FAs: <br /> w <br /> N NK CODEC N$WO AMOLANr R86VT'T= CHECKs1CAW affeuvED tY DATE FgW rocs VICE R[OUEST NLJMLFFI NNVDIC[ <br />