Laserfiche WebLink
APPLMATION FOR WELIJPUMP PERMIT -- -— -- -- I <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX at 446 N.SAN JOAOUIN BY,STOCKTON.CA 8620140 <br /> {2051 188.7020 <br /> N04REfUROAtIE PERMIT EXPIRES I YEAR FUN OAT[ISSUED <br /> lCao,YY Y Tekpe.W <br /> Applicstim is here by sada to the San Joeswin ComtY for a pamit to co,at,,,t and/or Install the wort described. This appllcetlm Is <br /> rode In coepliarrce With San Joe¢tin Canty Dewlopemt Title, Chapter 9-1115.3 and the St.W rds of San Joaquin Canty h Ilc Kuhl <br /> Services, Envirnvmtal HeAttth Dfvt/al�m. /� 1 <br /> �^ Jab Adiress/or�aAPNR / 39/ r. 1461`•-f q/ ' ,/LILY 4"�40� Parcel Site/APN/ �+-7 /_�1q <br /> Owawer'a Naas y2G �e /�1'S Lt�4S Address &I AIPI &l��F:a� �,4 �1 pRar / ;?,If- 9J /-7W/ <br /> [.tractor GtJ/aH /C Addrest;X66i I.Y�.LIJ5-�-3 E-I Ph- 10-11ya8-6vZv <br /> Sub Contractor_ Addrees Lid Phone B <br /> y <br /> TYPE OF VEtI/NMP: EI NEW WELL ❑ REPLACEMENT TELL 11 MONITORING CELL / 0 OTHER 150 <br /> to /Oa 0 DESTRUCTION 0 OUT-OF-SERVICE WELL (] GEOPHYSICAL VFLL / Bg1 <br /> LY SOIL "ING <br /> I — f—a [] INSTALLATION 0 tELI SYSTEM REPAIR 0 CROSS-COYNECT REPAIR 0 VAPOR EXTRACTION WELL I_ <br /> 9 l] Na (] ePelr N.P. DEPTH <br /> PM1P TET F1. FIRST W ER IEVFI_- <br /> •G a (TYPE Of � [• t /,� or�r Id n (7,,,.��Po1 -fit-. t�-iY`n� bY��,�ily S �{ <br /> V <br /> INTENDED us "i TYPE Of WELL CONSTRUCTION SPECIFICATIONS V ri�/ lice O <br /> ., Liz )nr�. <br /> ^. [7 IMWSTRIAL [] OPEN BOiION DIA. Of CELL E%CAVAT IN I DIA. OF CONDUCTOR CASING <br /> 1"� 0 —MIC/PRIVATE 0 GRAVEL PACK/SIIE_ TYPE OF USING/STEEL/PVC DIA. OF ALL USING <br /> PUBLIC/WNICIPAL (] DRIVEN DEPTH OF GROUT SEAL SPECIFICATION <br /> 0 IRRIGATION/AG 0 OTHER OOT SEAL INSTALLED NT WCIT BRAMD HANE <br /> t� 0 MONITORING GROUT SEAL PLIMPED: 0 Yea U No CONCRETE PEDESTAL BY DRILLER: 0 Tea 0 No <br /> W APPROX.DEPTH= lOt%lNG[NESTER BOX/STOVE PIPE <br /> V PROPOSED CONSTRUCTIORIOAItONO YETHOk MD NOTARY_AIR ROTARY__AUGER_ CABLE_OTNER­� <br /> C1 hereby c.rti', that 1 have Prepared this F'—'.tion and that the work Will be daa in accordance wiN San Joaquin Canty Ordlrorces, <br /> y r^ ubl <br /> State Law, And!0.ules W Re9uiat lorr of Ne San Joaquin Cm tY• Nana Owner or llceruM a0mt's .1"ture certifies the follwirq: •i <br /> acertify that in the perforsa tt of the wort for ahia this panit la la.md, I Mall not upl oy person aect to YOR/]4NI5 COMPENSATION <br /> Lew of California.- Contractor', hiring or nL-contractim Bi"ture certifies the follwinB: e 1 certify that in the pertorrne <br /> of the work for which this P ..It I. fa I chap aeploy Person L AjaCt to IARCMAY'S COMPENSATION Law of California.- TYEAPPOCAR <br /> �ry0 MUST GAtI 11 NW�iN\�E��■�/AOYAMlC_�/�FOR Y111L 0I/�S/�.E�TIORVSS.AT DOq N4K1i. CoopLet.drwin, attowerarea provided. <br /> q 519ned% `La /F 1 ti/1'Lll�n <br /> Title " �C{� �^Crj Date/��� 1 / <br /> VVII PLOT PLAY (Grew to Scale) Scat.__' tN <br /> 1. Neoea of street, m roads Hereat to w basdln, the property. A. Location of Naw sawW dlapoesl ayatw m <br /> 2. Datum of the property, Rivirg dieenaiaM W NPrth direction. proposed —pension of saWaPa dlspoul systes. <br /> IL <br /> 3. Dfearaloned .Hina oslou[Im o/ all esfatinB and proposed S. [h a rop of wor adjoiniin .dim of ng proper TV.150 it. m <br /> structures, includinN covered arm such es Patios, drivwari. / property <br /> W walks. JP A Qc <br /> � f1 <br /> --- ------------ <br /> --- --------- <br /> ----JLLdaz w&l film JOEL <br /> 0 Q C <br /> D ARTY T US ONLY <br /> Appllcatl.Acccpted By <br /> y � Date I -Z-Z'q Ara�L, <br /> Grwt Inspection BY <br /> Data Pulp Inspection BY Date__ <br /> Deatr tlw inspactim BY Date Cmment.:_._ <br /> 4� s a� <br /> A,COUNTING ONLY: AIOB fACY <br /> PE CODES FEE INFO AMOUNT REMITTED CNECNEICASH RECEIVED By DA PERMITIEEBYIGERHUEST NUMBER lffyo E <br /> . � r l <br />