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- r P. ' G-SIL—}`_"_!tom •-'-r l " : ;I ANYia;A 1IUN FOR WELLIPUMP PERMIT 5AN JOAQUIN COUNTY poStIC 14EALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P.O. BOX_Me, 304'EAST WEBER AVENUE;, STrrMN, CA 95201388 (2091 46$•347.0 KOiI•A£FtlR4A6_ll,PPRRIEY El(ASRES i YCAR 1110111 $RTF 133Vj O ' ��— tCompE+ts M Trq!"IratrE APPUCAT70N IS HERE BY MATO THE SAN JOAOUIN COUNTY TOR A PERMIT TO CONSTRUCT ANO/ON INSTALL THE WOW DESCRIBED.THIS APR.ICATIDN 16htipF IN COMFLfANCE WITH DE JOAOQIN COUNTY DEVELOPMcF?'r TITLE.CMAPTER 9-11 1S_3 ANO TME STANDAROS OF RAN:;OAOVIN CDlrNTY P'SBL3C HFALTH sEIIVICf8.CMYIRGNMENTAL HEALTH DIVISION. - 'Joe ADD$WI;&lOR APN#44-3 _.5 ycAr-fDP_F_- T?PE�I.T_ VuY._ HACKITc-e'.#�'••-----._.__ ✓ARCrL quVAPN#_ --RI T iC--� apCiRE98 ` 5 � —_ PHONE x(2D4)-$23-239 ptVHrR'$NAI.AE_ r VA-tJ_. _ _.._ -.__. __- C4HgRIf�_ 1wr.1Y1RUnf.M2r.1T TC-4NliDIDGI'r1uGoORe�e It4�f PHO,x�S!(f7 420 0 coNTaACToa —.— �-- TFEE-DwD`� -6$ C5 -4l3 5165 Gi2EG W �DRiL!_rl�� 11;►�1_D TE5TjQc, AOOArS8 95c_ b�-rr ►,�, "Cr p,loNt.L�lo l�?� eve CONTRArTOR ._ -- -- TypE 9 MIP: NsW'/.rEil, Cl RFPI.ACEMEhT wE'i,L 1qJ MONROFUN-a WELL 4—� _ LJ ()YMCA—' - -- . © INsfALLATIOH ❑ wEtl SYSTEM REPAM ❑ CA0SS4j).41EC7 AFPAIR LE VAPOR ExymcTION WELL 0 ❑N,_0 Pa", N.P. WrM PUMP Iscr f•'r. FIRST WATIR LEVE (701.OF FI MP) BOIL'SORINO . ❑ ?VTIIF,SER'srt:WELL ❑ LIEAP*tYdICAt WELA•,,,,_,_____, ❑pEgTRUCTfON: iNrq.DED usf TYVE OF WEit. cuNrRucTl17bv��rgCATIQPi•�,.1 ❑ INOUSTMAt ©OPEN 6grTONt DIA.OF WELL EXCAVATION _ DIA.OF CONpUCTOR CASINO NIA- 13 DoMEBTICmmVATE X GRAVEL PACXIM7,4 rY-K OF CAB4N618rEELMVC rYG- --- OCA.OF WDM CASINO x 11 ❑-t PUBUGA UNICIPAL ❑DWVEN DEPTH OF GROUT SEAL fO f emc3pfCATI t4 I SCH-f 4.0 g7^ ❑ OMMATIONIA0 ❑OTHER 1 T RtOtfT 6EAL INSTAL.LEO gY _{�_q�. Mr� r A GROUT mmv NANE P ORTLA-Mb T-I!L— ,�MONRORfNfs Y GROUT SFAL PUUP(O: I„JYw WIN. i CONCRETE PEDESTAL ON OWU.ERr®Y. N. � AP~X.OTN ZS ��1 _ LOCKING ll R w)(ISTOVT PIPE 4 f I PROPOSIM CONSTRUOTION10paw YO IrI!'1'HOO' 'JUD POYARY _--,_r.•AIR ROTARY AUOFR _ _CA$1# OTHER I HE'I OY CEIKrCV THAT;HAVE PpEPANEO TN18 APPUCATION ANO THAT:HE WORK WILL SE DONE IN ACCORDANCE WRN 9AN jOApWN COUNTY CpONARtCf6.STAT!!-AWB.AMC RUTAS REOULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR UCENSFD AGENT'S 8IGNATURE C-MlFIE$TME r-OkLOWING: 'I CERTIFY THAT IN THE FE160PMAPICE OF THE WORK FOR WH THIS PENARIT IS ISSUED.1 SHALL NOT D4Kgv PERSONS 8135JECT TO WOOmmmi'E COMPgrsATTON LAW'S OF CAUPORNIA.• CONTRACTOR'S HIRINO OR aye-CONTRnCTFNB$IONATURE CEFMI TlMf IvUUOWWO: 't CER'r'IFY THAT IN TME P'EAPORMANCE OF TM!WOFI(FOR WHICH THIS KRUM It fSBVED.I BHALI.EMPLOY PERSONS SU>S.1ECT TO WORKMAFYa COMPEIw*TmAr LAWS CAUFORMA.' THE APVMAHT MVi7 CALL u LOURS III ADVANCI FOR AtL R[etAweD INSPECTIONS AT f2"f us_Un. CO.APL.ETE ORAWINty AT LOWER APIA PROVIDED. TIN. -- D.Ia &Rllq% _ PLOT FIAM 1040-is SCAI.I 8wh •M .. I. NAlAtO Of$TR'MS OR ROAD.$NEAREST TO OR SOUNDING THE PROPERTY. - - Z. "TUNE O 4, LOCATION DF HOlTSE SEWAGE OS8PO8Al 6YSTEIu OR nwppOSED OIF Trwt PROPERTY-am"*DIMENSIONS AND NORTH OIItEC7ION. E7A TION OF SEWAGE D16AOS I 9Y6TEM S, ?. I�,IENSIONEn OVTLINFS ANO LOCATION OF ALL EXIaTTNO AND PROPp6ED 6. LOCATION OF V4L43 ugrN n RADIV9 OF 014P RUMORED flFrY Fr_ $TRWTURE9.INCWDINQ COVERED AREAS 6VCH AS PATIOS,DRIVEWAYS,AND WALK$, 7N THE PftFjEMY OR ADrO1NINO PAgPER-y. kN-bsITE� .Pry Aeplle.r+on.an..el.d Sy��-._______ ___ ._..._�____._ f • Rrr Q,�f S11�,{/ Grout In.p.ep.rl 6Y_ 1 P.Ie _Pw++.1r0tlon Ry O.tn O..R .o 4crto trwprl. Sv _ e h+. I , ._ __.. 0000.._.,_, •'_- Comm.rtt.' ACCOVIYTWC ONLY: PE CQDm !¢INFO AMOVMT REMITT EO H 6C TCA!!H RlC 3VEb i}Y SATE PEFAEIT:80tVlcE REGVFAT NUIV86R INVOFC! t _ i