Laserfiche WebLink
P. } <br /> N"w'APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O. 80X 384 304 EAST WE$Eq AVENUE,STOCKTON, CA V-nl388 <br /> 12091 468.3420 <br /> NOR-REFUIIDAREE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> A0PLICnT1OM/S ICompl.q M TT�7kaal <br /> /}ERE By MADE TO TUE SAN JOAOUIN COUNTY FOR A PEAMMIr TO C00ayWXT ANDTIR rM6TAtl 7HE M}OfOC DF <br /> JOA.COUNrV VCVrLOpW#,T Tn LE_CHAPTER 9.7 715.3 ANO TffC CST "DAM OF AN SCAWCO.TIfIe APPLICATION IS MADE IN CQIMPLucteCE WIT}I SAN <br /> 8 JOAOv14 cOUin PVauC"EALTH SERVICER-ENVROM/-IENTAL NEALTIf Orv16/pN- <br /> JOB AOORFssmR Aaxi ?UU S 1 Y LT1 T S(2��T // 1 <br /> CITY_ 7 Q�I Oyv PARCEL SIZEIADxr i <br /> OWN13 74--->'o<3 t 2 <br /> ER'R NAPE C 11 c U�R,cY") AbEHMSe_ 1 3 0k <br /> COiriRAcTOR g Co 12 ;N I ULNA i ON" L ADDREfie qa►� p ,slaE{S Yq4v V3 rJQ �ucr —' //� {11��QQ <br /> SLIa CONTRACTOR OCEu,�flT.J pk0'tf.("Ir�j &�t830 <br /> Aal>al� SbtA sRaf LICr VC13�3�� pNQNi, Ors 456 ' <br /> TVFK o-F W_ELVPVMP- o NEW WEI, D RCPCACFMENT WELL u <br /> �'T ONROwNfI WELL r <br /> LIINSTALLATIONQ WELL SYSTEM REPAIR '�— �•+ OTHF,R <br /> ❑ CpOSe-CONIfECT REPAIR <br /> D Ni..r O R•oy N p VArpR EXTRACTION V"ELL/ <br /> RYPF OE WMP} OFI•rN 6,fAIp SET 1T <br /> FIRST WATFR LEVEL <br /> Q oVT-oF-.REIrvICE WELL El GronIYS+CnI WELL r �} <br /> ❑MUTRUCTION- yaE SOIL DomNO <br /> A <br /> DITEXDEO UbE rrpE OF W�- <br /> LJ CURSTRUCTION YpECIFR%ATIONA <br /> INOUSTRiAt El OPEN sorrom <br /> 0 OOMMf9TIC/PTOYATE D(M^VEL VACILRRzE DIA.OF VwTLL EXCAVA2TR)N 11 Oor COA <br /> dA. /+ol/cTOR CnSINO <br /> TYI•r L CA-aN(I/RTFEUpvC A O <br /> 1] PrlauC/1.R7/ACIPAE {g DnrvErF Q,�Q,.Al —NJL oc WELL cAstMRt <br /> +^' I'TIf OF ORrIUT CEAL � O <br /> 1�,} IRRff:ATIQM/AG ❑OTM£R OEIV �'CFTCATtON <br /> Od NIOMroRrmo GROUT TEAT.rima-LED By a <br /> �+1,� GR7UT aRAAID NAMi <br /> Yt�c� <br /> GROW aEAc,I�rurcD. 0 ❑p,, E <br /> AAROX.OEpTN I CONCRETE PEDESTAL aY DIaL1ER:D Y.. QNv .T <br /> LOCXWV CNEaTER DOXITSTOVE RPE <br /> NMOfOLED Co"TRLAGTIOR/OIOE Ma MVTrMOD: LM ROTARY <br /> AIR R07Agr S <br /> AS R—C"L OTHER—�G` <br /> 1 NEREBY CERTAY THAT 1 NAVE par;PARED TLIIB APPLJCATR7y AND THAT TME Wop;:Ott R(C I>Q4E!N <br /> REOULaTIONR OF TTS SAN JOAOTJf►f t:OVKrY. HOraE OIA14F.R OR ACCORDANCE 11101 CA/J JOAOVIIJ <br /> rs"PERMIT to -92" ,l NOT El�rt;OT.p gO tICE1MEV AOENr•S Ek=NATURE CERTIFIEC TWE COVNTY OROR+wNCEB.Sr ATF r.�Vv8.Alvo RULF6.V+Q <br /> Bv9.JEC7 70 WORRrAAWS COyyEfeEATpN FOl1oWIMO!'I CEMMY THAT 16f THE"WORMIANCF OF TuE%yOpK FOR w,fC11 <br /> 7xE Folio 'I THAT M Tiff pSv"WjA4CE OF LAWa OF CAL60ataA- CONTRACTOR-8 <br /> CAIJFORM ,• T THE WO'W FOR WNR'H THIR PERMIT It IR raRr7rD OR VUR-COKTR/LCTINO 6WNATURE CERTIFIER <br /> xE 7 MUST CALL>A MOMS IN AOVANCX"it All.REOLLIM PIR.T,CMK*AT 72004 e� -OT PfRtpwS$QCT TO"0tlWAN•t CouvtWXAnoN <br /> Ina.d 2t. COII<ErE DRAWIMR AT LOWER ARFA r Vqo TVE uwt OF <br /> TRI. reTMl/T C VMa T- <br /> D..• � /O DO <br /> /.rNAMFS OF arREETa ORPLOT PLAN 10.•...,6++•I R..r. <br /> ROADf!taEAREBT TO OR eovtdnw p THE PMr"ITY. 'M <br /> 2. OuTLIME OC TUE PRppERTy.OIvwm D""VIONB AND rfoRrx dRECTION, A- LOCATION OP W <br /> J• D""ENBIOKO OLlt*`Ea ANO LOCATRTM OF ALL EXWPRT AND EXpA4M"OF llaF 4E bI PO OI OVAIT ><TBTEM OR I'n3P06ED <br /> aTRGCrLX1E8-a+GLIIOD+O COVERED PROPf'16E0 sEwAOE DlerOSAt arfrTEMB, <br /> AREAS SUCH AS PATIOS,OMVEWAry,ANO WALKS. t- LOCATIOM OF WEUS VMU"RAOXFa OF ONE NUNDRED <br /> FIFTY>T. <br /> ON TME pROP£RIY OR AIIJOTNINO PROPERTY. <br /> • .._ ... S• ... .. .. <br /> rIEPAATMRWT DMC ONLY <br /> Aod••rle.Ae•••re�/By <br /> a•IA 1,.�.c.I.„a <br /> T Ow• l` A•« <br /> a.1.` A•.IP ey <br /> O+nn.ne..h.•Pr/P� <br /> Or Du• <br /> - <br /> ACCO VMfTINO ORL 1- A)Dr <br /> FACS <br /> rE COOEA FEE INFO AAAOUNT RF]MITTED C <br /> WEC+cs}C/6x RECIIVED tT <br /> 3�D 1 - la5 DATE P9tufTISEN%mer REOU[fT NL)vagf <br /> INVOICE <br /> Pub.keatth Serv.-Erndro.773(3W <br /> n. <br />