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APPLICATION FOR WELL/PUMP PERMIT Do <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1p 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> MOI•MEFUMDAILE PEMMIT EXPIRES 1 YEAR FMOM GAIJ ISSUED <br /> IGNfIBu In lrlpkelEI <br /> APPLICATION IE HERE BY MADE TO THE WI JOA(P)IN COUNIV PoA A PERMIT TO CONSTRUCT AND/OR INSTALL TTN WORK DESCREED.THIS APPLICATION IS MADE N COMPL!ANCE WITH SAM <br /> JOAOUIN COUNrV OEVELOPMEW TITLE.CHAMTA 11-1115.5 ANO TINE ETANOAROs OF SAN JOAOUIN COUNTYPLIBLIC HEALTH RRVTCES,UPMONMENTAL WAITN OMSgN, <br /> JOE ADDIESM'IR AlINIJW-2 t <br /> C 'td /1 PARCEL S12EfAPNI <br /> OWNFRy NAME ,'1L4 MORESB L-1 mow .—�� <br /> Y <br /> CONTMCTOR Cilhrt1�� ADDRESS 16-)hA�dok UC/ PHONE I Z-C�10 <br /> WB CONTRACTOR AIbKH (ICF PEONS?/ <br /> iYPE OF wELtA41MP,. ❑NFYY WELL ❑REPLACEMENT WELL E❑MOWOrINO WELL F ❑OTHER <br /> U INSTALLAIION ❑WELL SYSTEM REPAIR Q CIeOEE CONNFCT RE►Aw ❑VAPOR EXTRACY?ON WELL,_ J <br /> ❑MPwUft—* M.P. DFPTHPOUPEFT fr. FMITT WATER LEVEL O <br /> [TYPE OF PIIfAP7 ` <br /> OlR#-RRVIC[ ❑ <br /> DESTRl1CiION: MIDEOYS'CAL WELL I ❑ sm SOPSNO E, L.l <br /> ❑ O <br /> IN Eb EE TYP OF ONSTRUCTION"SCIFKATIONS A <br /> ❑lHousTMAL ❑OPEN BOTTOM VIA,OF WELL EXCAVA110N OW OP'CONDUCTOR CASINO p� <br /> ❑TIOMESi1C/RIVATE ❑OAAllL PACKfS:T.'I TYPE OF CAENORTED-MvC OLA.OF WELL CASINO O T{ <br /> ❑FURCIC/MUMCIPAA ❑OWEN ONP/H OF GROUT SEAL SFECNICATION <br /> ❑RIRIOATIONIAO 110 THEM OROUT SEAL INSTALLED M OROVr ERANO HAMS <br /> ❑UONrtomm anoIlT RAL PVMFEO-❑Yr ❑1N CONCASTE PEOEeTAL BY MOLLER:❑V- [T.— <br /> APPROX. <br /> N.APPROK.DEPTH LOMINO CMERER 90K1SfOVE POE S 3 <br /> PROPOSW CONSTRUCTMIINISLLINO METMOO:UUO PIOTARV AIR ROTARY AUGIVI _CAM OTHER <br /> I HTV-Ry CERTIFY THAT I"AAE PR[PARED TMS APPLICATION AND THAT THE WOPE(WRL SE DONE N ACCORR—R-E WIT'A SAN JOAOUN COIINTY OnOWANCES.BTATE LAWS,AND IEKill AND <br /> RFOULATIONS Of TH[SAN JOAOLNN COUNTY.NOUN OVWOR L11CID RD AOENT7 SIGNATURE CERTBIES THE FOU.OWNe;I CERTtFv THAT IN THE PEKORA.AIICE Of THS WORK FOR YA11CH <br /> TMS PERNIFT M INNIED,ISHALL NOTEAN\OY PERSONS SUBJECT TO WOgVAAN'S COMPSIPSATON LAWS Of CALNOINIA.'CONTIIACTORS IIRIINO DR VIN CONTRACTING SFONATURE CE"IfIEe <br /> NFN FOLLnYwm: '1 CERTIFY THAT N THE PERFORMANCE Of TIN WON(Von V0*CH THIS PERMIT Is ISSUEO.I SMALL EMPLOY PERSONS SULACT TO WORSMAPI'B COMPENBATKIN LAYS Of <br /> CALIFOAAA" THE APPLICANT MINT CALL H NDUM M ADVANCE POR ALL RSOUSIW INSPICiIONB AT 1""464-9411.COMPLETE DRAWINIS AT LOWER AMA PRONGED. <br /> SIRrF1 • LF'tLL` C�-�.��_TIM ����.!_ On. ~) <br /> PLOT PLAIT 10—1.S AIAI <br /> T,NAMES OF STREETS OR MAUI NEAREST TO OR ROUNDING THE PROPERTY. 4.LOCATION OF NOUN SEWAGE DISPOSAL SYN71M OR PROPOSED <br /> 7,OUTLINE OF THE PROPERTY.DISA <br /> DIVING DFNSIOPIS AND NORTH DIRECTION, EAPANSIOp Of BFWAGE DISPOSAL SYERTMS. <br /> 1.blIMENSRTN ED OUTLNES AND LOCATION OF ALL IXWFMO AND Pm-oSFn S.LOCATION OF WELLS W"U N RADIUS Of ONE HIM/UIIFO FTFIY R. <br /> STRUCTURES.NCLWNO COVETED AREAS SUCH AS PATIOS,DRIVIEWAYB,AND WALKS. ON THE PTIOPRITY OE ADJOIRRM FIMFER". <br /> .... ,... .......... .... i .....i. .__. . <br /> s <br /> 1 <br /> : <br /> i <br /> L.. <br /> EJ <br /> .- �.. I.. .... y...: ..j..�. <br /> 1 i ? <br /> EP <br /> I ; <br /> i ? <br /> I <br /> 4 1 <br /> i <br /> VE D <br /> �....: A $I 1998 <br /> ..... . <br /> } 'eaMC INCLUVgIr <br /> ...i...' JGATxJ <br /> •.(..., N iRPO11LTH SE CES <br /> ..l <br /> .. ..: ? .,.I .; ••I [. .:._�.--I ::. - E Y NATE TA.L HEALTHPIVISTpILI" . <br /> ORPMTURNT VSE ONLY <br /> A,M..II—A—W d F <br /> n,slS F,PPsde,.1r DPI.. Pump Y,.PwO.n BY 0.1. <br /> I <br /> i <br /> AccoLIN TINT,oTwY: AAI incl <br /> I[COD" FFR IKFO AMOUNT IId11T1Fb N RCWWD ST OATS "MATamm.E PEDLAdT WAMER INVOKE <br /> 7L 049 V <br /> Pub.Heath Serv.-Em im 173(l AM <br />