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APPLIDA1IfIA1 EON WELL/MOO 61A Mit RECEIVED BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES XNT(11114".1EFfrIP.L HSALTH DIVISION P 0 BOX 19/1, 4411 N, BAN JOAQUIN TT, STOCKTON, CA 11321/14es jNIIMLE2N IIALIgIgliE A L T (2091 ABX3420 LOAM rik41119_,Y1111EILIALVALL_TEAR/A0111 DATE RIND ENV ji ICainsIste I. TriallastaI Application la here by made to th• San Jowyuln county for a permit to conatruct Ind/or Install the work de .11h0,441Y0On 11 aside In compliance with Ian Joaquin County Development title, Chapt•r 9•111S.3 and the Standards of ten osesuln County Public lieeth Services, Enviromentel Jab Address/or 2.. //S e-rk--,57-- 14/.96:11/1/~ 57: city s-5.7-C1 .,i'-z"4/ Parcel I toVAPHO Owner's litiaseye invel4icts, AddreaS 4i'lpir 5://-.t Phone Contractor PgaziA/ `c,„1'i"7",.,4)f (4 ° Phone • z- Sob contractor' Addrese Ilea C Phone N 3.1 ig4J' DIF OF WELL/PI-WI II NEU WELL It REPLACEMENT WILL K14011170RING NELL 0 D OT HER DESTRUCT ION II CUT-OF-SERVICE WELL I) GEOPHYSICAL WELL I II SCHL MORINO If INSTALLATION 3/ WILL SYSTEM REPAIR 11 CROSS-CONNECT REPAIR II VAPOR if New 31 Repair H.P. PEPIN PUMP OCT TT, Mist EXTRACTION WELL 0 WATER LEVEL (TYPE OF PUMP) WOR_DESJISI TYPE Of WELL cONSTRUCTION SPECIFICATIONS IT INousTRIAL 11 OPEN 11011011 DIA. Of WELL EXrAVATION gr--/71/el DIA. OF COisDLI;TOA CASINO 0 DCSIESTIC/PRIVATE 1;1 DRAWL PACK/SI7E TYPE Of CASIRO/STEFlfrvC• P(//‘. DIA. Of WELL :As1110 I/ PUILIC/MUNICiPAL II DRIVEN DEPTH Of GRCUT SEAL_F11- /2,cLear SPECIFICATION If IRRIGATION/AG II 01HER GROUT SEAL INS1ALLED RV a i i in/a/A.4Am? !RAND II kM$ K wOWITORIMO GROUT SEAL PUMPED: I) ye• f) Ilo CoNCRETIPIDE APPAOX. DEPTH 2. q,-,......,v7-- LOCKING CIIERTER ROX/IIOVII PIPE TAL IT DRILLER, If Yee If No PenPOIIIII CONIT/MICTIDNIDPILLING WiT110111 NW ROTARY AIR ArliAlls_ 00010.X CARA _ mitre , I Tirelfy certiii, that !tat, Lowe, end RU14e certify that in the performance Laws of Callfornle•" of the work for which MIST CALL To Noll ELIM\ADVANC Signed X -with I have prepared this applicetron and that the work will be tiono in accordance a and Regulations of the Sain Joaquin county. Nome owner or t loeneed agent ,. signetvr of the work for which this permit lo Issued, 1 obeli not 'apt oy persons oubj Contractor .* hiring or sul,contreating signature certIlltre the followinvi " I nor this permit 11 Issued, I shill errploy persons subject to WORKMAN'S CC•IPENSATICSI lows .1 !CO ALE ra Quint° INSPECTIONS AT 11011 4111-1411. Complete drswIng et lower amen p I 1 t 11%—c:0/ ..rA" /X... Joaqufn County Orgrlianoes, certifies the followlnst "I at to IFOOKNAN'9 COMPENSATION Ify that In the performence California." TNE APPLICANT ovided. , ei, • ..t-a"." / 112 ' (Ptot to •14, Vent, " to PLAN (Drew 1111 I. Name, of etrZa ae roede rlf111111t to or hoLolding the property. A. Looation of hout• . outline of the property, plying dImenelone anti Worth direction. • proposed expansion . Dimensioned outlines end location of oil existing and propoaed S. Location of wells structures, Including covered sssss such as patio'', driveways, the property or ad and welks. ..-CG=I-LW .2:11C ,-/PETIV,-T / Z' eunp• di nrosont snotty. or of sewege dIsrmset oyster., Ithin radius of ISO ft. on olnIno property. - — — -- OFPARTVENt USE ONLY Appt Nation Accepted Ny el/i/14.0--- Dote F/3/aV ::::6'?/' Grout Inspection AY Date pump Inepect ion Ey Destruction inspection by Date Carrnente! ACCOUND110 0111.Tt AMP FCC/ PE 000E9 -- FEE imro AMOIMI REMITIItTED CRCS/LOATH RECEIVED SY DAll rEmmistivict NEOLIENT MINIM! INVOICE 2-10 x- G 0 , _ - -5 t73 I L Alf,p 00 3 7f z__ - 4-17— „.01111110.40:1014.40. _____ --?-140fr--