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SUS CONTRACTOR ADTANF SR LICP PHONE <br />4. LOCATION Of ',out:if SEWAGE crisPoRAL irriTTEN4 OR PROPOSED <br />ExPArasTow or SEWAGE DISPOSAL rrescsag. <br />trtcArteu OF ,A,E1.1_13 Wrndlk RACIIU3 OF ONE IduNDRED FIFTY (7 <br />ON THE PROPERTY OR ADJOINING paopEpTyy. <br />PLOT PLAIN g....) 44o.„4, <br />I NAME.* Of STREETS OR ROADS NEAREST TO OR INTI.RiDeda THE pROPEyrry. <br />:I. OUTLINE OF THE PROPERTY. GIVING DIMENRIONG AND NORTH DIRECTION, <br />DRAENEIRDNIE0 OUTLINER ARO LOCATIosd OF ALL DON-TR/El ANTI pnoposED <br />STRUCTURES. IFICWO1NO COMIED AREAS SUCH AD PATP02. 0011v4wAT5, At4o WALKS. <br />RON-REFURDARLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />ICentplet• in Triplicate) <br />aorycnstou ts <br />Km SY MADE TO T SAN JOAOCANI COUNTY FOR A PEVART TO CONSTRUCT AINVOIE sdSTAll THE WORK DESCRIREO DAS APPLICATION IS MAOE IN Coupt.IAP4C WITh SAN <br />Jtmetrue cowry oEuttneutur rrris_ cf4Aprol 9.1115,3 AND THE sTANOAATIA OF SAN JOAOUNI COUNTY PURUG HEALTH sERvscEe: ENNAPoQuENTAL WEALTH OrvIstON <br />RIO Ao0RESsioR Arwo 6:k•t2 /6/1--(7/ //--/?*‘4.14"-r <br />owFtERAt F.mxiE dg-C-0 I04.-)14C-M. C---a4/1-1P*-t4 AnoncSe r• 0. x . ,z•-ft7.t-G4 2:3(2Y'yt, -(085— c.-RAcTon Gr/e-s-r- Dtfte-,No ADORES; 1You.,..55-ii9 7 III40.4 • 010636 72 / <br />-32 3 _3 ec 7-2 <br />CITY PARCEL SIZE/APR., <br />rn' <br />I HEREEsy CERTIFY THAT IllAvE PREPARED THIS APPLICATION AN0 THAT INN WORK IA's!, RE CORE od ACCORDANCE wITNI SAN .ADAOVIN COUNTY ORDINANCES, STATE LAWs. AND RULEs AND <br />REGL/LATIONS OF THE SAN XIAMEN COI/NTT. HOME owoerR OR LICENSED AGENT'S SIONATURE CERTIFIES TRE FOLLOW NG, CF,RYKY THAT IN THE PERroremANcE 00 THE wow con ye.oyocfg <br />rms pETRATT IS ISSUED, I SHALL NOT EMPLOY PERRON/9 BUELtEcT TO WORK-UAW( COMPEIMAT1ON LAMM OF cm.TrooreA: CONTRACTOR'S HIESNO OR SUS -CONTRACTING SKINATURE cEsTiFtER <br />TINE cOLLowsseo, - CE/TriFy THAT Rd TNE PERFORMANCE OF THE wORK FOR Tvwicx TIDE N,ERART IS ISSUED. I SHALL ftiPt_or r•Enteo,Ts sosir-cT To wortEmpors oo....E-waATIow LAWS <br />CAUFORMA. THE AppuoApty MOAT CALL 25 MOLAR IN AovAiscE SoR ALL REOURICT) lwAIMOTIONA AT MORI AIDN-1421. CONTLETE DaAwINI9 AT LOWER AREA provIDED. <br />Cnry.,/ X te'e4I /07724.4.,f, ‘.5-c2.4 — 6 — „ <br />• <br />Nx AIDS AcCOUNTIIII0 ONLY! <br />0.• lc c , Pump ey <br />o.) 1 I C.)r) <br />ON• Irmo....Ion by <br />U! <br />Cx.••••wym-ri, <br />Pub. Hearth Setv. - Enviro. 173 (3/96) <br />PE CODES FEE INFO AMOUNT REMITTED CHECKINC•SH RICE:EYED ET DATE PLAIRITMERVIC.c RECRKFT NUN/SUL INVOICE <br />3"Z 4a ..c, 0 /001,14/ 5-11`)/ 002.2_W2S <br />APPROX. OUT F. LOCXINCI cF•EuTEn norATTov( pipt <br />11+FFP_OTFIEFI PROPoSED CDRISTRUCTIOILDIRILLINCI METHoo, MOO ROTARY ArR ROT 41V X auckg CARLE <br />/410/4( f?' (Ai 67 6 Ve€45 (711 ()45/1/1.-L1 Xt4) <br />0 DESTRUCTION, <br />TYPE OF WELL/PUMP: NEw wELL <br />INSTALLATioN <br />NyAor 0 Ressar <br />(TYPE OF PtiaApi <br />REPLACEMENT wELL <br />ID WELL SYSTEM REPASI <br />OUT-OE:AERvICE Y.TLL <br />)8( WELL II <br />0 CROSS-CONNECT REPAIR <br />Df.DTH gET Pr. <br />or.oPHYSICAL wig; s <br />OTHER <br />VAPOR EXTRACT/0N wEie <br />FiRST WATER LEVEL <br />soli 10,-,,NG <br />CRA. OF CONOUCToR CASINO <br />OIA: OF WELL CASTRo <br />SPECTFIC AT70 <br />(MOUT MAIM NAME <br />CONCRETE PEDESTAL BY DRILLER 0 No <br />INTENDED USE <br />RdousT <br />o DOMESTIG/PmvATE <br />PUT/LIG/MUNICIPAL <br />TYPE OF WELL <br />0 oPEN COTTON/ <br />OTtAvsl pAmprzt <br />D onivEw <br />IRRIGATION/AO 0 OTION <br />MONIITORTNOAPyCIA- <br />CONSTRUCTION SPECIFICATIORA <br />DIA. OF WEIL EXCAVATION <br />TYPEO CARINors-rEtiipy, <br />DEPTH OF GROUT SEAL <br />(ROUT SEAL INSTALLED SY <br />OROLIT BEN relsAPCD, UN.