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P. 1 <br /> ST ..,1A-1 997 i P=59AM FF-0M <br /> 93PUCATION FOR WELUPUMP PERMIT' <br /> SAN JOAOUiN COUNTY PUSLiC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION �G nS <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 hU <br /> (209) 46&3420 <br /> ROW-REFUNOARI ERMTT EXPIRES I TEAR FROM DATE ISSUED <br /> (Compists i9 TrfplbW <br /> APvLICATION IS I(ERE BY MADE TO THE SAM JOAOUIN COUNTY FOR A PERMIT TO CONeTRUCT ANO)OA INSTALL THE WOW DESCR39ED_TIBS APPLICATION IC MADE IN COMPLIANCE WITH SAN <br /> JOAOUIN COUNTY DEVELOPMENT TrRE.CHAPCTER 9-111 S.3 AND TME STANOANDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. �/J-171-0d-0 <br /> -3 q 3 7 V r I Y G r-+— uJrc crTY v 4Tc k� PARCEL 09ZFJAPN* <br /> J08 ApORfSSgA APT11 /Z/l <br /> Its o v .L I L ld ua re ` .1 <br /> Ov q+ER'S NAMC 13 P A m e rye -t_n c - �n�f. Pr� ADOPEBS c 2 cLPI // PKQNE s <br /> t t-t� r c S` a �`Jw+o <br /> CONTRACTOR P7..1-scns L-TZ I/1Qe.ri,t- T'I,G AOORfes c ' <br /> ry 5o OL04L! a i0)3r;3w3 <br /> MA CONTRACTOR t,7 YQ,' ..�-T'l' S t ( -�-✓L C ADOr1Ese NLS, (�.A "C_e T - NE a <br /> TYPE OF K'ET,.=mp:l NEW WELL. ❑ REPLACEMENT WELL );�MDNROIuNO VvELL a }I�g�OTHER <br /> ❑ rNBTALLATION ❑ WELL sYsTEM REPAIR C] CROS9•CONNECT REPAID 1L7.VAPOR EXTRACTION WELL a <br /> ❑Nwr O fLPMr H.P. O.EPTH PVatl•`R@T FF_ �-Rp s-T WATCR L[V£l._ <br /> C1 <br /> ( OtIFOFSERVICE Wt.k l.i OEOI'NYr:IC hl\YELL! (zOR BO r'7A1'J B <br /> OFBFRUGTq N; <br /> A ot r4 <br /> INTENDED USET TPE OF WELL CONSTRUCTN*PF.CWCATfON• c; a <br /> ❑ INDUSTRIAL ❑OPEN BOTTOM O.A.OF WELL EXCAVATLON 3— r` OIA.OF CONDUCTOR CASINO [� D <br /> ❑ 00 ME9TIC/PRIYATE ❑ORAVEL PAMMZE L�Z TYPE OF CAS1N0/sTE J �G��!• �/U'u� 6 U aw Oi WELL CASINO �- +� -1 O <br /> pEP'TH Of GROUT CFitL 'L''7 v SPECIFICATION A <br /> ❑ PUBLICJIAUMCrPAL ❑DRIVEN <br /> ❑{M1YWGATgN/AO ❑OTHER OROUT DEAL*WTALLED By / .e r3,L(-e- OROVT BRAND NAME f <br /> IFl UOWTOA/NO t OADUT SEAL RJMOCO• ❑Yw ❑No. CONCVCM PEDESTAL B`/ )MLLER: Vr ON- S <br /> APrveo X.DF7TIr IOCIUNo CHISTm 6OX"STow FPL s <br /> PROPOSED CONSTRUCTIONIUICLLNO MCI-Woo: MUO ROTARY AIR IOTA" HS A 2AUGER { CA9LE OTHER <br /> 1 HE-EBS'CERTIFY THAT 1 HAVE PTFPAR'ED TINS APPUCATION AND THAT THE WO" WIU-BE DONE M ACCORDANCE WITH CAN JOAQUIN COUNTY OPOINAWtV.aTAYE LAWa.ANO'WU0 ANO <br /> nEG%/1aT/0H9 OF THE SAN,fOAOUM COVNTI'. HOME OWNER OTl UCEN"o AOENT•6 NNINATV.IL CTATIM0 THE TOLLOW1NOe'i CERTIFY THAT 1N THE PERYORMAA/dCE Of TIIE W"FK PW <br /> OR HICH <br /> TMS O'ERMfT le ISSUED,f s11AL1 NOT WPLOY PERSONS Y'VBJCCT TO WOIOOMAWS COSAPWSAT19II LAWe OF CALS0011"A.- CONTMCTOIt'S HNLNO OR SVB-GONrpACYINo WONATURt CtFrrF EER <br /> THF FOU_OIT 18 't CERTIFY THAT IN TICE PPERBAMANCE OF THE MIOIfC POA VJHtCN Z"M¢ptp off It 199L/ED,1 SHALL"A L:OY PERSONS SUBJECT TO WOR"AAW9 CO.•TF-"nAMN LAWS OF <br /> CAL/fORN1A.' THE APPLICANT MULT CALL 201I.DUR1 IN ADVANCI POR ACL WaLARE&INi1SCTfON6 AT tsDsY"`tia•JCOUP'j,L"TE DRAWING AT LOWER AREA MO\ <br /> f'..Lit:L.C.L <br /> PLOT PLAN(0T-.r to 9e-0•1%.+. -to <br /> 1. NAMES OF 9TREETS OR ROADS NEAAE9T TO OR BOtRMING THE pAOP£HTY, 1. LOCATION OF HOUSE C DISPOWAGESAL <br /> DISPOSAL 9Y9TEM OR PnOrVSED <br /> 2. OUTLINE OF THE PROPERTY.Or AW DIMEIISIONS AND NORTH DIRECTION, EXPANSION OC 9fWAttE gSPOs+tL S8 O EMS. <br /> 9, D74ICHS WGO OUTUNF,9 AND t.00ATION Of ALL EXMT940 AND PROAOGW i. LOCATION OF WELLS%WrWN RADIUS OF ONE NL/NDIIED FIFTY FT, <br /> 9TRUGTUREe,INCLUVINO COYMO A04AIP®VLH AB FAT10G,DWAWAYB,AND WA KIL ON THE PNOVEM OR ADJOINING PROPAJLTY. <br /> /V SiR <br /> JAle Nu� <br /> tl/s v� .v✓. .Z.....f`.Ilan d / : . <br /> . Y <br /> pr�p <br /> Vit ONLY <br /> AoVI1•.o-,A.~.d BT - <br /> D...—PvrnP tn.y.W. BT O.t• <br /> o.•u r..f.ut•n BY , <br /> i Rf <br /> AccouNTrr+o ol+tr: AID7 FAcs <br /> PE CODES pa THFO AMOUNTC�ROATTED GHEC[Qo/cASH Rzc9v$D Lr OAT[ P9VLII7/tEAVlti IIEOt1E67 NVINS6R INVOICE <br /> 7/ <br />