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/ 1 EMIBONMENTAL HEALTH DIVISION <br /> / F 0 e 388, 445 N. SAH JOAGUIN ST., STOCKTON, CA 96203-386 <br /> (209) 468 3420 <br /> A N REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Complete in Trtpllcllt/} <br /> N,a HERE BY MADE TO THE SAN JOAOUI OU FOR A PERMIT T4 CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED THIS AppI,1CA716N IS MADE 1N COMPLIANCE WITH SAN <br /> DEVELOPMENj TITLE CHAPTER 8 1 AND THE STANDARDS OF SAN JDAOUIN CDUN� C HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> loop, �` ly CITY C /PARCEL SIZEIAPNIr �/ 7 7 ! <br />,Ca A I FtESSMR APIN �y��y/Q y J�^ (� /7 r ` PHONE T 4 1 -IO 1 1 <br />�yVNER S NAME I I l U VII'1 L� l UC= L I ADOFiESS L.� L� f� t.i. GL WTI <br /> -7 r1 (/ <br /> 1zZU l4}I�YR��CIt� 1 n�L�C/�PHDNE R 3 S 1-�17s0 <br />:ONTRACTOR 2�G /�]U1 �r1 "+•l�� `s G` UIC'E't ADDRESS �f� <br /> �.;+.�7 "111 �UZ� r �,� ADDRE66•-U � �• 13G� -S�PHONE! <br />,US CONTRACTOR t..1 1+-V <br /> �MONrTORING WELL/ © OTHER <br />'Ytx OF ELLY�IMP ^7 NEW WELL ❑ REPIJICEMENT WELL VAPOR EXTRACTION WELL# <br /> D INSTALLATION 12 WELL SYSTEM REPAIR ❑ CR036-CONNECT REPAIR p <br /> DEPTH PUMP SET----Fr FIRST WATER LEVEL <br /> ❑New 13Reneir H Pr' <br /> RYP�E OF�PUMP! SOIL BORING B <br /> ❑ DUT OF-SERVICE WELL ❑ GEOPHYSICAL WELL# <br />❑DESTRUCTION A <br /> CONBTRUC710N SPECIFICATIO NB 1 I O <br /> IHTEN�ED USE TYPE OF WELL DIA OF CONDUCTOR CASING <br />❑ INDUSTRIAL 0 OPEN BOTTOM DIA OF WELL EXCAVATION -21, <br /> -7 ,,T - D <br /> TYPE Of CASINGISTEELJPVC 1f c— DIA OF WELL CASING <br /> pOME5TlCRiVATE GRAVEL PACKJSIZE SPECIFICATION A <br /> 1P <br />.^,. PUBUCIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL /v 44 � - E <br /> r. GROUT SEAL INSTALLED BY-` ^r-t Alj GROUT BRAND NAME <br />.�I IRRIGATION/AG OTHER 7C.. CONCRETE PEDESTAL BY DRILLER [3Y. ©Nn 5 <br /> NlONTTORlNG f _ r GROUT SEAL PUMPED 11Yr e S <br /> I LOCKING CHESTER BOXJ <br /> APPROX DEPTH J AUGER!CABLE—OTHER <br /> P41gP0/LI? RI <br /> CDNBTRUCTIONJDLUHG METHOD MUD ROTARY <br /> AIR ROTARY <br /> E 6 AND RULES AND <br /> IN <br /> INA <br /> I HrREB CERTIFY THAT I <br /> OF THE SAN AVE PREPARED <br /> RED THIS <br /> HOM OWNER OR LICENSED AGENT 6 SIGNATUREWILL BE NCERT!IES THE FOLLOWING 1 GERT[E IN ACCORDANCE WITH SAN lFY7HATrIN THE'PERFORMANCENCES TOF THE WORK FOR W141CCH <br /> RI GULA <br /> T RMrT I6 165UED 1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN 8 COMPENSATION LAWS OF CALIFORNIA' CONTRACTOR S HIRING OR SUB-CONTRACTING SIGNATURE CEFIT1Fl <br /> ES <br /> 7 SUBJECT TO WORKMAN S COMPEN <br /> OWING <br /> WINTHE PPLI CERTIFY <br /> THAT IN THE <br /> CALL 24 FORM NCEO F THE CE ORICOR/.FOR LL RIMMED HIS PE TION/MIT SAT5120Y1 4U.3423MCOMPLET PLOY PERSONS DRAWING AT LOWER AREA PROVIDED <br /> RATION LAWS OF <br /> IN L <br /> Dete <br /> Title <br /> S1Qnea X <br /> PLOT PLAN IOraw to Sodel Saelo— ' - to Z <br /> 4 LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 1 NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY EXPANSION OF SEWAGE DISPOSAL SYSTEMS Y_ <br /> 2 OUTLINE OF THE PROPERTY GIVING DIMENSIONS AND NORTH DIRECTION sem• -^"-'�'--�'�`r .�' <br /> 3 DIMENSIONED OVTUNFS AND LOCATION OF ALL EXISTING AND PROPOSED ; <br /> STRUCTURES INCLUD — 1-0119 089 <br /> s w WRIGHT ENVIRONMENTAL SERVICES, INC. <br /> CORpORATION HEADQUARTERS 90-1031 1211 <br /> 9US LIC NO 651501 <br /> 1+,1 1961 HILLTRACY, CA 95376 33756 �1 19 r <br /> + <br /> PAY <br /> SCOL 0 acJ3�U W��` TMJ <br /> ORDER OF pOLLARS 4 <br /> i <br /> y7t r �L <br /> Rey!y <br /> 4 j/Nt semeA <br /> t1 <br /> 4; YOFFICE lYP <br /> 1175 TIM Blvd Iraq CA 9SM <br /> FOR—11? 1 <br /> �NGIlie 108911■ 1 10 10 6 �o <br /> Ire L,u,� <br /> �] FoQc>R MAP,-A- <br />