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LOCATION Of vrousE SEWAGE oisPosAL tint-m.4 or PROODGED <br />EXPANSION OF SEWAGE INSPottAL OYSTE3.19. <br />I. LOCATION OF WELLS WEENIE( RADIUS OF ONE HUNDRED FIFTY 1-7. <br />ON TnE PROPERTY OR ADJOINING PROPERTY. <br />Rot rum <br />) NRWE Or STREETS OR ROADS NEAREST TO OR SOUND/NEI THE pEorrErrv. <br />OUTLINE Or TUE PROPERTY. ODANO DORENAVNE AND EIGINT44 04TiECTION. <br />3. DELEENSTONE0 OUTLINER AND LOCATION OF ALL EXTSTR/G AND pr5rogE0 <br />STRUCTURES. rnett/Orno COVERED AREAS SUCH AS PATIOS. ORIVEWAYE, AND WELKE. <br />ELITE; InN,FEMR eY DNA <br />iNTSMDED 1/61 <br />CI INDUSTRIAL <br />El DocatETIOnFarvAT <br />0 riftnicmitEEGIPAL. <br />sERICATION/AG <br />U kaotoToRIND <br />APPROX. DEPTH <br />TYPE OF WELL <br />0 OPEN EOTTOM <br />f-IORAVEL PACK/PrZE <br />ID DRIVEN <br />60' <br />OTHER <br />0 OTHER GROUT SEA!. mfrrallEry ey <br />HEWES,. cERTEPI THAT I HAVE PREPARED TWO APPUCETION AND THAT Tv* WOW wn.k RIF DONE IN AccorloAnct wryn sAar JOAOUIN COUN-ry pROINANCCE. STATE 1AW5. aka nutEs AND REGLRATIONS OF THE SAN JOAOUTEI COCRITY. HOME 0....".mck OR tfewsEo AOSN1-111 EMMA', DOS GERTWW6 THE FOELowiNG, -1 GET:MEV TNAT W/ TEIf PEATORWNCF Of Tur woRK Fort WI;SCN THIS PERMIT Ea ISSUECI, I SNAIL. NOT EMPLOY PERRONE EIUSJECT TO WOerKE•Ekrit COmPENTIAT1ON LAWS Or CALIFORNIA.' CONTRACTOR'S HIRrNO OR FEUS-CONTRACTING SIGNATURE cE_FITIFIEs INS FouowiNo; I C.ERTIF'Y THAT IN THE PERFOTEMANCE Or 711E wORIC FOR PASCH THIS PSR.NT IS IRELtED I SHALE EILAPLOT PERE:ONE Si"...rEGT TO WoRicMAWII COME.ENIEATTON LAINg OF CAL/FORMA, THE A ANT ACME GAEL 2A MOURNIN ADVANCE OR AU. REQUIRED INAPECOOPES AT MIEN 4611.11471. COMPLETE DFLAWTNO AT LOWER AREA PRovioED. <br /> 0••• 3-cy-7o SI- TM* <br />akeefteotte--. A00*.ce.4 Ely <br />0.0%.4 Ir....so..., Sy <br />C NEL. 1.4/V.C. i v.. I-I I •z_ C`C- <br />ON• <br />DoNnvlit•••• L-41seatia." fly <br />GDRIETRUC'HON SRDCW1CATIONa <br />ESA, OF CONDUCTOR CAS/NO <br />OM. Of WELL CASINO <br />rPSCIFICATION <br />GAELE <br />GROUT GRAND HANIS <br />GORGRETS PEDESTAL BY °Ralik Elyo. 0 No <br />A <br />0 <br />DM- OF wEl. EXCAvamon <br />TYPE Or CARIENIESTEEL/PVc <br />DEPTH OF oantIT SEAL <br />Gnovr HEM otrurco. 0 y...; UN. <br />LOCKING; CnEwrEn no:AL-Tout PIPE <br /> AIR ROTARY AtiCkE PIEOPOCED GONSTRUCTIORIORELLINO METHOD: MVO ROTARY <br />DEEILETMENE USE ONLY <br />5-3-1997 2:2SPM FROM <br /> <br />P. 1 <br />APPLICATION FOR WELLJPUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />RC. Box saa. 304 EAST WEBER AVENUE. STOCKTON, CA _.201-388 <br />(209) 469.3420 <br />RITN-REFURDARLE PERMIT EXPIRES I YEAR ERORI DATE ISSUED <br />IConiplats in TrioScats) APPLIGATiou S rak-RE MADE TO THE SAN JOAOLEIN COUNTY FOR A PERERT TO CONSTRUCT AND/OR INSTALL THE WORK DFSCRIEED. THIS APpLICATION IS MADE IN GomptlANcE vorof TAN ;MAMMY GOONTY DEVELOPMENT T/TLE_ CHAF'TER 9.1 115.3 AND THE STANDARDS Of gAM JOADUR/ COUNTY PUBLIC HEALTH SERVIc1S. EfateEtwuEnrtAk wsikuria orvisioN. <br />Joe ADDRESS/OR APN/ 2-05 egewza- sr-AV -0 - 12.5 PARCEL SIZE/API/. <br />OWNER'S Nsk4E 4 U 1:712c,1)1,4e. Arxwtr_se,c, /11-viAA441.4 Y/61 0,410t,v.t./44 A,,G. <br /> co.A.c7o. -411111111ailligni* , <br />(,(Z -At 4 6--3•3 SUB CONTRACTOR ADDEEr SS UCEE PHONE, I <br />HEW WELL REPLACF.MENT VVEU_ moNiTogiNG WELL , 0 OTHER <br />1:1 INSTALLATION 0 WELL sysyEAr nEsAsk 171 GPons-Gommser nspEin VAR EXTRACTIoN waL <br />0 Now 0 H.P. 0E 0n-4 JUP SET TT. ryst-T WATER LEVEL <br />0 OVT-OF•ITERV/GE WELL OT.OPELYSICAL WELL t sOU._ Itarnuo <br />ryis oir vvELLIFif m <br />17YPE OF PUMP) <br />0 OSsTnoc-non, <br />ACCOUNTING ONLY: AIDS PAGE 1 .,— <br />PE CODE. FEE 174F-0 AlL401pri REF.FITTED Gl4t-cicorcEew 111cErvE0 ay DATE 11113P/111W-ThEs 7‘11C-4101.4 INVOlc E <br />Pub. Health Serv. - Enviro. 173 (3/96)