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DED Uy RKM A ❑ IINULIV L /13 OPN BOTTOM I� DIA. OF CONDUCTOR CAFINO LF D D A-W.1AVATE jyMFPWJTYPE OF CASINO/i1EELTGIA. OF WHL CAEIN ❑PUBUMVMRAL UDRV[N EPTH OF OROVT CEAL SPECIFICATION ❑RMAT*NfAG ry OTHER GROUT FEAL INSTALLEDBYROVT NIANO NAME f ' 1:1 MONITORING S GROUT SEAL PUMPED.w- ❑Ns CONCRETE PKM ST AL BY bNUER:❑ Yr IL s APPROOm" LOCKING/O E117M BO%IAOVE PRF S PROPOS(b CONBTRUCTIONIMLUNO MFTHOO: MUD ROTARY AIR ROTARY AUGER CABLE OTHER I 114MOY CERTIFY THAT I HAVE FRFARMO T I. APPLICATION AND THAT TER! WORK WILL /F DONE N ACCOROAHC[ WITH SAN JOAOUIN COUNTY ORDINANCEI. WIATE LAWS. AND RULES AND REGULATION 9 OF THE SAN JOAOUM COUNTY. HOME OWNFA OR LICENSED AOFMI-S SIGNATURE CFRTIFTES THE FOLLOVANO: 'i CERTIFY THAT N TIME PERE0IOAANCE OF TIIF WOPK FOR WINCH TMS PERMIT It ISBUEO, I BNALL Not IMPLOY P*MONS SUBJECT TO WONpFANS CORIP[MIATION LAWS OF CALIFORNIA.• CORrPACTOFTI IRRING OR IUB.CONIRACTNG MONATURE Ctrair EI 7HE FOLLOWING C W THAT IF IUORMANCE OF TME VJOIK FOR WNICH THIN PNILIT It IIIUED, I MALL EMPLOY RFIION/ SUtJfC1 10 WOFUOMAN'S COMPIN A M UW/ OF CAUFON/A.• MV HOURS N ADVAMCi PM ALL MGISA [O INtIRM=S Ri 1]MI AM -1 ]1. COMPLnI DMVAFN AT LOW AICA MqN SIaFN A 9 T.I. bI. ROI RAR ID,n W Beall SMP_L' is / 1. NAMTS DF STIIEFT/ OR IgAOt NE 11E TO OR BOIINONO IN PROS'[ OF NOUS[ IEWAGE OItrom SYREM OR PNOIOSED ]. OUTLINE OF TME PIK/PEPITY, OM M�r�r.,�M��BR]M/ANO FIORIH OR1ECiION. [ A NOF /RYAO[ d/POSAI IVSTEMS. ]. OIMFNSNNIED OUTUMTI AND lOC "'9' ALL [1VtTINO MID TOIO!!D i. L Of WI1.LI WITHIN MbVS OF OM MVNDIfb IPTY ff. $IFRRfLARR. INCLLIOINO COVEF D BUCH AS PATIOS. CNVEWAYI. AND wwct. n Fw-Iwrry nA an w.n... er.n...,.' A.r�G1 D.0 � p o� 117 APPLICATION FOR WELUPUMP PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH NEN ! 304 EAST WEBER AVENUE, TOCKTON, CA 95202 SCANNED (209) 468-3420 NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE it SVED ICompl/(I iR TI�DCSIM) APPLICATION H HERE BY MADE TO THE BAH JOAQUIN COUNTY EOR A PERMIT TO CONITRUCT A"WOR INSTALL THE WORK DESCRREO. THIS APPLICATION IS MADE M COMPLIANCE NRTII SAN JOAQUIN COUNTY DEMof%WW TITLE. CHAPTER 0-1116.3 ANDDTTHI STANDARDS OF BAN JOAOUIN COUNTY PPUJB/Ut HEALTH S"MCEB, ENVIRONMENTAL HEALTH OMOMN. JOB ADDRE"MR AMI !.�/ /Q CITY ^,}CJ'E�f�'--- PARCEL SIZVAPNE �//, JL�/[C�_'. OWNER'S NAME. (/F//� CONTRACTOR Cy/�.��J J+I/N_1L AOOPF96 PHONE /J DRESS U G PJI_I,O.N., RVB COMMCTOR� 9 +y TYPE OF MU PUMP; ❑ NTN W VLL ❑ REPLACEMENT WELL ❑ MoNOONHO WALLS ❑ OTHER ❑ WALLATION ❑WRL %91 EM REPAIR ❑ CI,o BS -CONNECT IIEPAW ❑ YAPOR EXTRACT" VYELL I Jr,— ❑ Nw 11hp�r H P,� DEPTH PUMP tET [ f. FIRST WATER LEM � 7 p I� y nmE OF PUMry I ❑ OUT-OF-SEINKE WELL Cl OEOPHYSICAL WELL / ❑ COIL BORING B O ❑ D[[TRUCTION; DED Uy RKM A ❑ IINULIV L /13 OPN BOTTOM I� DIA. OF CONDUCTOR CAFINO LF D D A-W.1AVATE jyMFPWJTYPE OF CASINO/i1EELTGIA. OF WHL CAEIN ❑PUBUMVMRAL UDRV[N EPTH OF OROVT CEAL SPECIFICATION ❑RMAT*NfAG ry OTHER GROUT FEAL INSTALLEDBYROVT NIANO NAME f ' 1:1 MONITORING S GROUT SEAL PUMPED.w- ❑Ns CONCRETE PKM ST AL BY bNUER:❑ Yr IL s APPROOm" LOCKING/O E117M BO%IAOVE PRF S PROPOS(b CONBTRUCTIONIMLUNO MFTHOO: MUD ROTARY AIR ROTARY AUGER CABLE OTHER I 114MOY CERTIFY THAT I HAVE FRFARMO T I. APPLICATION AND THAT TER! WORK WILL /F DONE N ACCOROAHC[ WITH SAN JOAOUIN COUNTY ORDINANCEI. WIATE LAWS. AND RULES AND REGULATION 9 OF THE SAN JOAOUM COUNTY. HOME OWNFA OR LICENSED AOFMI-S SIGNATURE CFRTIFTES THE FOLLOVANO: 'i CERTIFY THAT N TIME PERE0IOAANCE OF TIIF WOPK FOR WINCH TMS PERMIT It ISBUEO, I BNALL Not IMPLOY P*MONS SUBJECT TO WONpFANS CORIP[MIATION LAWS OF CALIFORNIA.• CORrPACTOFTI IRRING OR IUB.CONIRACTNG MONATURE Ctrair EI 7HE FOLLOWING C W THAT IF IUORMANCE OF TME VJOIK FOR WNICH THIN PNILIT It IIIUED, I MALL EMPLOY RFIION/ SUtJfC1 10 WOFUOMAN'S COMPIN A M UW/ OF CAUFON/A.• MV HOURS N ADVAMCi PM ALL MGISA [O INtIRM=S Ri 1]MI AM -1 ]1. COMPLnI DMVAFN AT LOW AICA MqN SIaFN A 9 T.I. bI. ROI RAR ID,n W Beall SMP_L' is / 1. NAMTS DF STIIEFT/ OR IgAOt NE 11E TO OR BOIINONO IN PROS'[ OF NOUS[ IEWAGE OItrom SYREM OR PNOIOSED ]. OUTLINE OF TME PIK/PEPITY, OM M�r�r.,�M��BR]M/ANO FIORIH OR1ECiION. [ A NOF /RYAO[ d/POSAI IVSTEMS. ]. OIMFNSNNIED OUTUMTI AND lOC "'9' ALL [1VtTINO MID TOIO!!D i. L Of WI1.LI WITHIN MbVS OF OM MVNDIfb IPTY ff. $IFRRfLARR. INCLLIOINO COVEF D BUCH AS PATIOS. CNVEWAYI. AND wwct. n Fw-Iwrry nA an w.n... er.n...,.' A.r�G1 D.0 � Naal[h Salv. - Envila. 173 (1197) w1mm"I VMS Naal[h Salv. - Envila. 173 (1197)