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-- <br /> APPLICATION FOR WfLL)PUMP PERMIT <br /> SAN JOAau COUNTY PUBLIC H=RVICES <br /> ir -1-fi SL ZMENTAL HEALTH Q IT'ir cor. <br /> 'p <br /> EAT WE13ER AVENUE. STO&*M� <br /> )p-A SA IlWrc <br /> Q09) 8 20 <br /> s a <br /> sp.8c <br /> iAl, <br /> 11011-JEFUNPABLI PERMIT FS I MR FROM 091E ISSUED <br /> Memplate]a Tf*BwtW <br /> APPLICATION Pa HERE BY MADE TO THE SAN JOAQUIN COUNT['FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DE86MUD.THIS APPLICATION Is MADE IN COMPLIANCE VOTH BAN <br /> JOA()UiN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1115.3 AND THE STANDARDS OF SAN JOAQUIN COU HEALTH SERVICES,ENVIRONMENTAL HEALTH OPAIRION, <br /> JOB ADDRIESS40011. 7(142 k'i'lp ed I CITY gte <br /> PARCEL SMAWJ <br /> 6VAA&TR,B F 447 ADDFIESOZ*�? PVOONE'Z� <br /> C <br /> SUS CONTRACTOR LICIF�-_PHONE I <br /> TYPE OF VVILLIPUMP; ;G4FW WELL 13 FemAcEmeNT WELL 0 MONITOPINO WELL IF (3oTmm <br /> 0 INSTALIATION [I WELL SYSTEM REPAIR C1 CMS@,CONf4WT REPAIR 0 VAPOR WAACTION WELL 0 <br /> rrvm OF PUMM (3m&.13nwwf H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL <br /> 13 maTRucTsom 13 OUT-OF-W WELL 13 mopwfoicAL WELL 13 SOL BOOM <br /> Imiremm m ly"Opm CONSTRUCTION OFIEWMATIONK' A <br /> 0 INDUSTRIAL 0 OPEN ROT-TOM INA.OF WELL EXCAVATION MA.OF CONDUCTOR CASH <br /> %uj)OMESTIcmmVATE MRAVU PACKMIZE TYPE OF CAafNGfflTEELTW— VIA.OF VWU CAGING <br /> 13 rummimuNlcim 13DFmH DEPTH OF:GROUT BEAL SPECIFICATION <br /> 0 IFIRRIATIOPUAG ❑OTHER GROUT MAL INSTALLED Ery M4 u it, t GROUT XtAW NAM LaV19 <br /> 0 mowroniNa GROUT SEAL PUMPED4ky- Orft CONCRETE PEDESTAL BY iitum(3 Y. L If <br /> APPROX.D"T"—ZZQ—�-- LOCKING CHESTER BOXISTOVE PIPE <br /> PROP0461)CONSTRMTIONM"LUNG mer"ob: MUD ROTARY AIR ROTARY AUGER OT"Ek <br /> I NEWRY CERTIFY THAT 114AVE PREPARED THIS APPLICATION AND THAT THE V40M VALL BE DONE IN ACCORDANCE WITH SAN JOAGU*I COUNTY ORDINANCE111,STATE LAWS.ANDRULESAND <br /> REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER On LICZASED AGENT'S BIGNATUM CERTIFIES THI!FOLLOWING."I CERTIFY THAT IN THE R1MANCE OF THE MFIK FDR VM <br /> THIS PERMIT 19 ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WWWMAN'S COMPENSATION LAWS Of CAPJFORNIA.' CONTRACTOR'S HIRING OR OUIF-CONTRACTWOMONATUIRE COMFIICEHO <br /> THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 08 IOWA[),I SHALL EMPLOY PERSONS SURJtCT To WORKMAN'S COMPOISAVMN LAVA OF <br /> CALJFOANIA.' THE APPLICANT MUST CAIJ,24 HOURS IN ADVANCE FOR AL%RIGUIPIED RUWWTIONS rAWAI 4M-3422. COMPLETE DMwm AT LOWER AREA PROVIDES. <br /> C <br /> 64pwd X TIUe /2 <br /> '-d <br /> PLOT PIAN(W&.v to GomkI sowq 'to <br /> 1, NAMO OF STREETS 09 MADS WAIWaT To oft ROUNDING THE PROFCArV, 4. LOCATWN(IF 101181!SEWAGE DISPOSAL BYSTEPA oft PWPOKD <br /> 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE 01911`06AL SYSTEMS. <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED 5, LOCATION OF WFUZ WITHIN RADIUS OF ONE HUNDRED FIFTY FT.- <br /> StRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PRDPEM1Y OR ADJOiNfiNG PROPERTY. <br /> ............ <br /> 140 m <br /> .. ......... <br /> PAY ENT <br /> ........................ <br /> vql) <br /> RECO. J: <br /> SEP 2 6 1997 <br /> U�" <br /> 5AI4 JOAQUIN C0Fjv4QFs-- <br /> ..,jj6jjCViEALT14SF VIVISIOW <br /> OUBVIHO1��AUTH <br /> .... ......................... ....... <br /> Appilostlon Amempied By— DEPARTMENT USE ONLY Dole <br /> A r,-Iq 7 <br /> Grout imapeation ayr—e-d 2 By— Date <br /> Destructlen limpow Ion By <br /> Date <br /> Commeffir el� <br /> % <br /> 44 9EAA ITAA�c <br /> ACCO #-rr'msce-j*z <br /> IAITING ONLY: =FA.0 <br /> PFi CODFA FEE INFO AMOUNT REMYTED G;�ZICASH RECEIVED BY i DATE PERIATISEWMIE RVMMT NUMBER <br /> INVOICE <br /> 46 -3 <br /> 43-70 ED 7W Ar) 40 L 0 <br /> -7 <br />