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APPLICATION FOR WELLIPUMP PERMIT 11 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES r <br /> ENVIRONMENTAL HEALTH DMSION <br /> P.O. BOX sed 804 EAST WEBER AVMUE,STOCKTOK CA SMUMa <br /> (209) 488-3420 <br /> 11011• EFUNDABLE PERMIT EXPIRES 1 YUR FROM DATE 18800 ORIG) NAL <br /> mamplisto In Trfp&XtB) <br /> APPLICATION IB HERE By MADE TO THE SAW JOAOUIN COUNTY FOR A PMOM TO CONSTRUCT ANDIOR*WALL THE WORK gESCROM.THIS APPLICATION M uwa IN GOMpLw=wrrm am <br /> JOAOUW COs' 1 t 19.3 THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SE W=G.ENYRWommAL mWATN Mv=p, <br /> JOB AOORESSAR APN. CITY S c k fViA 2-37 ac:e 6 <br /> L PARCEL FAMAPNf 5`03 G^o el <br /> ONAQ"NAMEf� <br /> ` ! � ALWRE PHONE <br /> CONTRACTOR_ 4 H i ,,y 1 H I I.{t,r �rej Z d!�+VLf Crw uC. P 1�. s S b <br /> SCIS CONTRACTOR C'L l�0 Awam C& Lms 21�$ FIIIII9E AI ^p RZ <br /> 711P�OF WaL1AA,lpr ❑ DmwwiLL 0 RBPI ACVMW WELL 00 IKOtW omm WmL I � ❑ O!Hml- <br /> ❑ LHSTALLATtON ❑►YELL BY6rm REPAm 13 cao cDKpa=RYAADI KP-6S 11VAPOR E awwrm WELL.a <br /> rrm OF PUMPI 13N.13RaPdr H.P. DEPTH PULP SET FT. K p—clS FIRST'WATER LEVEL <br /> ❑ OUr4)F. CE WELL ❑ OEOFNYSMAL WELL I 13 SOIL BORING g <br /> ❑WOM ED 6liSTRUCTLON: <br /> OIL rm - Aj CONE N lCIATIOO/B fl A <br /> 13 munmcomwWAL ❑jDm�7TO1/ 11�GO+eirel GIA.OFWELLERCAvAT1ONs�� OK OPCONVUCMCAB= a <br /> ❑ OOMESTICIFRiVATH L�7 dFi1t17lV1EL� PACIRNW—.. A TYPE OF CA 1 [ Il �'O W&OPWILL,CASINO 8 <br /> DEPT1f OF GROUT SEAL _ GFECWICATION R <br /> GMATIONIAG ❑OTHER GROUT 6LAL uftTALLMO L+Yu_rw DRovr ERAr�NAME Q I/lrl Pf/� E <br /> MONITOR I OftDUT BEA,PIAAPED Yr v Ne CommTE PBpC8wa BY ORAD Yr [3p;. 9 <br /> APMXDWTNS"(IyW 22, bee - ! LO�7Ctl�OBeHEarlT,Box16TOVMPSPBTYd TriL �Ci�p T �4J�9 iiiOt�19� $ <br /> PROPORM CONSTRIIOTI vavplLLnN METHOD: MW ROTARY AIR ROTARY AUM_4=CABLE <br /> 1 HEREBY CODIFY THAT 1 HAVE PREPARED TM APFIJCATION AND THAT THE WORK WILL BE LANE IN ACCORDANCE WITH BAN JOAO=COUNTY OIIONANCES.STATE LAWS,AND RULES AND <br /> REGULATIONS OF TM SMI JOAgUSQ COUNTY. HOME OWNER OR LICENSED AGENT'S BKLIIATIIRB CM,trIEg THE FOLLOW00i'I C80I Y THAT 9N THE PMRT OMANCB OF THE WORK FOR WH1CN <br /> rM FSiW11 W MGUED.I SHALL NOT EMPLOY FEItJ3ONO SUBJECT TO WOR10"Me COM MILATION L%WB OF CALF 0RNW- CONTRACTORS W=OR SOON RAOTM MaNATLAM Cog <br /> THI ROLL,OWMt 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHPCH THM PUMUT IS ISSUED.I SHALL RUPLOY POWNS SUBJECT TO WaP=tAWS DOMPEUATION LAWS Of <br /> CALWOR10A.' THE ALPPUCA WW Nn=CALL 24 DI ADVANCE FOR ONOipj i WNCTIONS AT r2a9)400.242'. COMPLETE oMWGID AT LOWER AFtEA PROVIDED. <br /> Oved X u�aLi�� Tri eco" •,,, -- 0. 4 1 Z <br /> PLOT PLAN Mkmw to v*o*l a- -tl <br /> 1. NAMES OF STIAEETS OR ROADS NEAREST TO OR BOU O M THE pROpERTY. 4. LOCATION OF HOUR BE1lVAGE DISPOLIAL ayWrEM OR PIOFO= ~ <br /> 2. OLMUXB OF THS PROPERTY.MUM DMENUMNS AND PRMM LTGOCMiN. EXPANNON OF BEWAM DnOCRAL BYSTdME; <br /> 3. 006MMONM OUTLOMO AND LOCATION OF ALL E1(W=AND PROPOSED Q. LOCATION OF WIMA Y9rrMN RADIUS or ONE HUNDRMD FIFTY Fr. <br /> SrRUCTLIREI,MLLIDDIS COVERED AREAS BUCfI AS PATIOS,ola nwAYB,AND WALKS. ON THE PROPERTY OR ADJOMNG FHopEf ff <br /> .. <br /> jar_ JQ'/meq/� <br /> .......... .............. .......... .-..—, :I <br /> A <br /> AppO-BDEPARTELBR USE ONLY <br /> we m�Ptsl By `� <br /> V VV V <br /> Greta R>:Peat4en BT �limpwdm <br /> cam. a XP D 5 S5 c ! Is 604. <br /> ;tPx0a;vrj <br /> Wn B4 Ofd y: AS7I PAC/ <br /> PMEDOAO AIMOuwRLHIpTTBD CHECgAeAs11 RT OVED BY DATE r � ✓ <br />