ARCHIVED REPORTS XR0000985 - Laserfiche WebLink

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N JOAQUIN COUNTY PUBLIC HEALTH SERVIW ' ENVIRONMENTAL HEALTH DIVISION P 0 BOX 8, 445 N. SAN JOAQUIN ST., STUMON, CA 96201.388 (209) 468.3420 NOM-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICamplati in Ttipl'IL:ati) ON IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANO/OR INSTALL THE WORT(DESCRIBED.THIS APPLICATION Is MADE IN COMPLIANCE WITH SAt Jk0JOCOUNTY DEVELOPMENT TITLE,CHAPTER 9-111 S.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALn4 DIVISION, la ADDRESSlOR APHl S LCA - ' CITY CiL�-1 V rI PARCEL SCMAPHO 7 � ` OWNER'S NAME Lj r O I i'VA.reADDRESS W k_q (Y'[-, PHONE P �NTRACTOR a CONTRACTOR OF WELUPUMP: ❑ NEW WELL D REPLACEMENT WELL MONITORING WELL 0 1,1 �r•J ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL 0 J ❑Now❑Rapwr H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL C (TYPE OF PUMP) ❑ OUT-OF•SERVICE WELL ❑ GEOPHYSICAL WELL! ❑ SO[L BORING B DESTRUCTION: IHTFNOfO USE TYPE OF WELL CONSTRUCTION SPECIFICATION& A INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION i] DIA.OF CONDUCTOR CASINGG DOMESTIC/PRIVATE GRAVEL PACXJStYE TYPE OF CASINGISTEEUPVC_- - p 5�� DIA.OF WELL CASING--4z_ !n �^ L U ❑ PUBCIMUNICtPAL 11 DRIVEN DEPTH OF GROUT SEAL 37 +/Y.t—.}+ SPECIFICATION S '4 r R IRAIGATLON/AG ❑OTHER GROUT SEAL INSTALLED 8Y I'�G GROUT BRAND NAMELI�� L?,�11.?c.f' F OX.OO H GROUT SEAL PUMPED: ❑Y. � RI NO CONCRETE PEDESTAL BY DLLEH.A Y. 13 No S LOCKING CHESTER BOXISTOVE PIPE PROPOSED CONSTRUCTIONMMLLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER E4E9Y CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AN LLATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING.'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHIC - PERMIT IS ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORIQMAN'S COMPENSATION LAWS OF CALIFORNIA SUB-CONTRACTING HIRING OR SUB-CONTRATING SIGNATURE CERTIFIE LLOWING: 'I CERTIFY THAT IN THE P£P-FOPMANCE OF THE VVOFK FOR WHICH THIS PERMr IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WOWOMAN'a COMPENSATION LAWS AWS C IA.' THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTORS AT 12091 4e*-3423.. COMPLETE DRAWING AT LOWER AREA PROVIDED. T10- V �J PLOT PLAN (Or—to Sr lal So+1. 'to NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSE OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH OIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. O(MENSIONED OUTLINES AND LOCA-TIONALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS.DRIVEWAYS. AND WALKS. ON THE PROPERTY OR ADJOINING PROP1:ATY. .. .. .. ..................................... .. .. i .....:.......:..............:......<-..............:......c...... .. ......... .. .. ............ .. - .. .. .. ....................... .. .. .. .. .. .. -. .. .. .. .................. ....:.....�1 .... ......'.......i...__.J.......:......:.......i.................... -- ................................... .. .. .. .. ............... -- '_ ......... -- -' ...-..... .................. ........... .. .. .-..-.... .. ... .- .. -........ ......... _......__. ._. .. .. _..-......__