Laserfiche WebLink
t <br /> r <br /> AFFLICATIOH FOR WE UMP PERMIT Y <br /> 3 SAH JOAQUIN COUNTY PUBLIC HEALTH SERVICES ORIGINAL <br /> f ENVIRDEMEII I -HEALTH DIVISION Qx;Zb2.. <br /> SD4 EAST WEBER AVEIM STOOMR CA� <br /> (21191 45alluzard#'Z�p1 <br /> MON-REFUNDABLE PERMIT <br /> APPLICATION IS HERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A FERMI TO CONS'i%JCT AMAX INSTALL THE WORK DESCRMED.THIS APPLICATION is MADE IN COMPLIANCE WITH"N <br /> JOAOUM COUNTY DEVEIDPMewr TTTTLE,CHAPTER 9-11,1'/55.3 AND THE 6TANOAROB OF SAN JOAOLPW PUBIC HEALTH SERVICES.EUVIHONMENTAL HEALTH ommoN <br /> JOB OR <br /> AOENVOR APW I &00 D{ECIJIA— � PARCEL SMVAPW /��yy Z�3� •VU <br /> OwNEWO NAME TdSG d bd C,ts n.� �� ✓ ONE r <br /> CONTRACTOR Y l✓ /!�✓f ADMIEcc 6 cr Zy ` PHONEs�-yy5� <br /> SUB coPrrmcroR ADOREST. LIG PHONE r <br /> TYPE OF WELLmmp- ❑ HEW wmL IBJ RERwCEMFNT WELL ❑ mowrommmu, ❑ OTHER <br /> ❑ 00STAL,ATIO01 ❑ WELL SYSTEM REPA/l ❑ wApt ❑ VAPOR EXTRACTION WELL r J <br /> ❑TY.v©11WW H.P, DO"PIIMPSET Fr. FIRST WATER LEVEL O <br /> {TYPE OF PLOM _ <br /> T .rt -,. -. -4�-„�_ �.❑ ovT aflewcf wExi -❑oeDrHrssAt i saRNa f <br /> --' <br /> ❑marmw"OIM: <br /> wrmbm Hot TYPE OF WELL Co"Tram:mOf1 APECIFICATIO A <br /> ❑ mmusrpwu. ❑OPEII BOTTOM LUL OF WELL EXCAVATION DIA•OF COIAXCTOR CASINO - D <br /> ❑ DowmTmwmvATE Ll bRAvEL P^cKm E TYPE OF CASINGISTEELRVC LUL OF WELL CASINO D <br /> ❑ RAILIC MPiK3PAL ❑DRIVEN DEPTH OFH:ROUT SEAL iP4CMa:ATM R <br /> ❑ 6VYOATIOWA0 ❑OTHER - GPCW SEAL INSTALLED BY GROUT!RAND NAME E <br /> ❑ MOIATOMNG GXXI T SEAL PUMPED ❑V. 0 N. CONCRETE PEDESTAL BY 0mulk-❑Y. ❑N. s <br /> APPROX IIEP'TN - - + LOCKING CHESTER I DOXISTOVE PIPE <br /> "wPosm CONLTRUC71ON7 mLm METHOD: MUD ROTARY AM ROTARY AUGER CARL: <br /> I i1EgE.Y CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SE DONE IN WITH SAN JO^MM COUHFY OFD4NANCES.STATE LAWS,AND RULES AND <br /> REGULATIONS OF THE S"JOAOUM COUNTY. }TOME OWNER OR LICENSED AGE WM SIGNATURE CERTI 999 THE FOLLOWIN(L-'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICR <br /> THIS PERkUr IS ISSUED,1 IIHHALL NOT EMPUDY PERSONS SUBJECT TO WOPOMIAWS 'I I'S KATION L^W i OF CALWON .' CONfRACTO"IIRNG OR SV-CON`MA=NG WONATURE CUMIRES <br /> THE FOLLOVANO: -I CERTIFYTHAT M THE PEW000AANCE OF THE V40W FOR WHICH TIRE FVWI I IS I kWJM,I SHALL EMPLOY M430M SJWi TO WO/IgNAM S COMP046AWON LAWS OF <br /> CALIPORAOA- APry,1CANT MUST HOURS M ADVANCE FOR ALL IIEOUWdW II{A CHM 400-2-9=. M <br /> 0-2-9=. COMPLETE LIMWING A`LOWER AREA PII VIDED. <br /> Blpr�d X TM. Oatr <br /> PLOT PLAN IO...+a 9a.H.7 GP.b .�u . <br /> 1. NAMES OF CTREM DR ROADS NEAREST TO OR DOUNDOM THE PROPWrY. A. LOCATION OF HOUSE SEWAGE INWoSA1 SYSTEI.I OR PROP05ED <br /> 2. OUTLINE OF THE PROPERTY.Of~DIMENSION6 AND NORTH ORhECTIOK EXPANSION OF SEWAGE DWPOSAL SYSTEMR. <br /> 2. ONENSIONED OUTUP U AND LOCATION OF ALL EXISTING AND PROPOSED F. LOCATION OFYVELLC WITHIN PLOUNM OF ONE HUNOFIED FIFTY rr.' <br /> STIMOCTMICE,I/ICLUDOM COVERED AREAS MUCH At PATIOS.I)MVEWAYS,AND WALKS. ON THE PROPERTY ORADJOMIHG PROPERTY. <br /> YllfQl..�1 ........ ...... <br /> L.....;.. .:.....:....................:.r.._. ON CK -.MAP �� <br /> ..............­ <br /> . i <br /> --------------------- <br /> IN Q.0jjNTy <br /> MAP INCLUDED IN WORKPLAN ENWI� <br /> - :AL�iEALTM DIVL:10N <br /> DEI•ARnwivu LIFE 01 MY <br /> Appb""s Ab"Ored BY D.I. .9� At—�15fDl(/Y <br /> G.«x I�P.eelon BY - - .Pum kwo.et+on D.I. <br /> D..tmu tlan 61-Pee" by 0.t. <br /> CemrnwMr. O . <br /> ACCOUNTWO ONLY: I'll FAC! <br /> PE Cconct FEE INFO AAAOVNr 90964TTED -CHECK XASR OtEC'OVIEb tY D.AfyTE x�. PEIMALRHIVIC£RMUSIT N/Ntmulm INVOICE <br />