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APPLICATION FOR WEU.)PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON.CA 95202 <br /> (209)468-3420 <br /> NOW R VICAlif PERMIT a u l I TEAL TRIM RATE ISSUED <br /> APPLICATION I■HlAE By MADE TO THE SAN JOAOI!•F COIFNTY FOR A PEH1.Wi t0 CMoONSTPLICT AHMA SMALL THE MAK DESCARIFM TIM APPLKATION 19 MADE IN COMPLIANCE VRTOI IAN <br /> JOAOUN CObfRY O(vFLOPMFM TrTLI,CHAPTER 111kW THE STANDARDS DF BAN HIGHER C PUBLIC HALTSERVICES. NVIRER MAL NEALr""m N. <br /> oe AOONESOR APHE F__ <br /> CITY /1 I PAACFL IgFIA PEI <br /> OV www HAAPEfler AOORIIS A PHONE f <br /> COMPACTOR •^C <br /> AC011FI• L1C 4 V P.O., <br /> IW COMPACTOR ADORE■■ LOCI RgF1E r <br /> f <br /> TYPE OF WLILMAv, 0 NEW WEU. ❑REPLACEMENT WELL ❑MONTTem"WELL I ❑OTHER_ <br /> 1h ❑INSTALLATION ❑M'-11 SYSTEM REPAIR ❑CROSICONNECTP @PAM ❑VAPOR EXTRACTION WE[L/ J <br /> 1.1I1►�L�. ❑H"' (b►�' N.I. __ O[PTN PUMP SET FT. FfKW WATin LEM O <br /> rtm of IRhq ------ <br /> vVf[S�'TT , 1 vF.!E�1 E w[u ❑o(or+�Ywcu wEu r ❑ .o1L wnNo 1 <br /> f DIS111IECTIDN: ,LA' l <br /> j fffINTINGED W! TTP/OP WElI. TRL1C 110M �A NNEs A <br /> ClINI USTMAL .OPEN BOTTOM DIA.OF YWLL EXCAVAMN DIA.OF CONOUCTOR CASNO D <br /> ❑DOMESTICA VATT ❑GRAVEL PACKM21_ TYPE OF CA-q JOrSTEtL.F•VC CIA.OF WELL CASINO O <br /> ❑IRmKAASwCS'At ❑IMVEN CEPTH OF GF10VT 19AL SPECIFICATION R <br /> ❑1FM4A71ONfA0 ❑OTHER GROVr VEAL INSf ALM eY arm"SRVA NAM[ E <br /> Cl AEOMTOPINO OROV7 WAI MP&TO:❑Y_ ❑FL. CONCRETE PED[STAL SY DM1IR:❑Y.. ❑N. S <br /> ATIOIX.D"74 y LOCKINO CHESTER SOXRTOVE PIPE S <br /> PEIOPOSM COMST"MTl"fD/LUNG MEIN b: MIA ROTARYAIR AO1. AVOER__u CABLE OTHER <br /> H IfMffv CEATIFY THAI I IIAVE REPAIRED THIS AF'PLICAIMN AN,THAT THE"MIK WRL BE DONE N ACCOfOAKI LATH SAN JOAOUSI COUNTY ofIANAHCF/•STATE HAWS,ANO nR[e AFIO <br /> PEOLRATIONS OF IIEE SAN JOAOUM COl/NfY.IIOLIE OWNER OR IK(NSW AOl M'I SgNA1UFE CEM SEI THE fLL10'Mq:'I COF/TSY THAT N THE rETEWSA ASIC(OF Tf11 WV ER FOR WHICH <br /> THIS FEAAXT to ISSII[-0.I M1ALL Not t"K' FFRSONI SVSJECT TO WORKM.%Mt COuwNSATIOR LAWS OF CALWOIMA•CONTRACTOR'.HRgq OR SUiOMMCI*M SPINATVEE CURTMDe <br /> TtFE FO '1 CERTIFY THAT N THE PEKOPMANCE OF THE WORK FOP WHKN THIS r'pSArr M HMUEr,E 9"^LL EMPIOY ramea"IVSJ[CT TO WOIIOIM"•S COMPOFSATI0II LAWS OF <br /> CZ; 9LAA—IJIM C -WT CA A 1 •N ADVANCE(/EKl ALL ml AxRSB TINN AT COMPLETE DRAWRNH AT LOWER ATEA RIO <br /> PLOP rLAR ro.Wr t.IeY.I.c.l. •1. <br /> 1.CHIT 8 OF STFETTS OR ROAD/NEAMST TO OR ROVI/OSAT TTM HIC/ERTY. I- ATION OF"OUSE/(WAGE OSSPOIAA SYRTM OC PFK11V SIb <br /> Z.OUTLRR OF THE PMPIATY,Or.Vft ORAENIIONS AND NORTH DIRECTION. EXPANSION Of SEWAGE DI/MSAL SYSTEMS. <br /> ]-OMRNSIONFO OVILNFA ANO LOCATION OF ALL EXISTING ANO PPOPOSEO S.LOCATION OF WELLS WT1M MORS OF OM HUMMED FIFTY FT. <br /> STFNCTUME,NCLUDOA COYtEED MEAS SIKH A/PATIOIL bFIYEWAYI,NSI WALXS, ON THE P"OPFM OR ADJORIM PROPERTY. <br /> � 1 .;��T�D trot <br /> N ( <br /> AAAA.... :. _ •. a <br /> J _1D <br /> W l �. <br /> AAbG <br /> "U.:"A1C HEALTH SERV.C!55 <br /> !;:nrlH;;n ii E[a;.4i.HE.ALTE,DI'JI:,ICIf: <br /> ... ... ____:AAAA. ..........._._AAAA . ...................AAAA.: <br /> 1 OO MT'10/T VEE ONLY 7 7{ <br /> G...A�nP>allew Sr_ D.i. F1F.rP rwsaewr,sr oal. <br /> O...niN.n I�.s,Ife•.Sr 0.�_ <br /> Cww�M.: <br /> ACCOUJTWO ONLY: ASIA FACT <br /> rt CO FTE INTO AAWUNT RFANTTtbHECI .CAST/ RECBVTD IT D4�[ tl/BTVIC!R[OtJE1T INVOICE II <br /> I <br /> FLh HOeth Sew.-Emmo.173 fI,57) <br />