Laserfiche WebLink
` 11 -95-1997 I :SSPM FROM P- 2 <br /> PLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> 304 EAST WEBER AVENUE, STOCKTON,CA 95202 <br /> (209)468.3420 <br /> NOW-11EFUXUABLE PERMIT EXPIRES / YEAR FROM DATE 1SSi1 <br /> Matepbrs k Trfpfkrbl <br /> APPLICATION 18 HERE 8Y MADE TO THE SAN.IOAObW COUNTY FOR A PgtWT TO COPMRUCT AM11MR fM7rALL THC WORK OESCRSED.TNf APPLSCATIOx to MADE W COMPLIANCE WrrN SAN <br /> JOAOtIIN COUNTY OEWCOMIENT TfltE-CHAVTFR 9-1 115_,AND THE 67 OAROB 8.#N JOA COUNrY DV81JC TH SemlicEB.ENVIRONw"ITAL NEALTM OrVm ow <br /> JOB ADOWSSIOR APN/ t� '`( ' PARCEL=M/APNI <br /> OWNfrTB NAME <br /> 1 \\ ADORE'59 PHONE f <br /> CONTRACTOR DCCW(! CV�Q � <br /> vI10NE t�Ib .xvl�I�i� <br /> i � Stwclt fZLO <br /> Bun CONTRACTOR '0i eC--Y\ f••t AOON'i8a `\�S ;� L/Cl�.s'� � j z7 R�OI�f IIJ z8(I to L9(1 <br /> TY>:p 9f 1Nf;1.1JFUM►, ❑ NEw WELL 0 REPLACEMENT Wnt Olt—MTOPING WaL/ L„ D OTHER <br /> I] rNgrAtLATION ❑WELL CYSTEPA REPAIR ❑ CROS®CONNECT REPAIR Q VAPOR EXTRACTION wFLL P i <br /> ❑N...❑R.P.1r H9. DEPTH PUMP SET VT. F1RGT WATER LEVEL O <br /> TrYPE OF Pump) �A(Qt/ <br /> Q OtTTOF-SERVICE WfLl ❑ OEOPMTT�CAL WET.L f f�80rL 80R7No <br /> ❑OEBrRVCTION; Y ` <br /> rN7ENDm uiE Tref Of WELL cONsrwuCTroN_sv T1aNs <br /> ❑ E+oK/sTRtwC 0 opm SOTToM GIA.OF WELL EXCAVATION Z // 01A.OF CONDUCTOR CAWMQa <br /> 13 0 <br /> OONfES7tC11PPaVATE ❑GftAVEI PAdc/eaE TYPE OF eATetwlGrsTEEt1PVC DIA.OF WELL CASINO <br /> ❑ PVSLICARINICIPAL ❑ORIVEH DEPTH Of GROUT SEAL `^ 4,.� SPECIFICATION D <br /> R <br /> iRRtOATIONIAO ❑OTNFR GROUT SEAL RISTALLED SY GROUT S/NND NA/dE <br /> (� E <br /> IAOI7tTOtYI'K3 ICA, <br /> I <br /> GROUT SEAL PVMPEo:O Y.. ON. CONCRETE PEDE8TAt 8Y DmtJ ER❑Vw ❑N. <br /> -I�// S <br /> A/P110Z_D1�TN ` tOC[e16 CHESTER SOXBTOVE PR'E <br /> PProEOSED C0x877rOc710N/DIR7.fR0 1IPSTipD: 1.rllD fbTARY ATR ROTARY AUGER CA9LE_ OTHER�� <br /> I HEQESY CERTWY THAT I RAVE OREPAREO TNIB APPLICATION AND TNAT T71E%WW WILL eE DON!iN ACCORDANCE WLTH 6w►+JOAOUIN COUNTY OROMANCEB.STATE l/KWa,A <br /> TlEGV1-ATtON8 OF IME 8ANS AMD <br /> Ot11N COUNTY- --OWNER OR LICENSED AGENT'S SIGNATURE CERTIGIEG THE FOLJ.O{MNGt'1 tfHTOy TNAT RI THE PERFORRrAr10E OF THE WOgC fND OREWNICN <br /> rflra PERMrr to ISSUED NOT EMMOY PERSONS 6U JFCT TO wo tOMMFS COMPfNgAT10I9 L.AWB OF CALWQ," .- CONTRACTOR-8 MvR&M oR <br /> THE OOLLOWWO: FY T14AT A "VS•COITTRACT11P6 SIGNATURE CERTIFWS <br /> NCE OF Tiff WORK FOR W/OCIK TiR6 PEN.eT 18 1ee1/En,t�/AI.0 E7APLOY PERSONS RISJECT TO MtOROAAx'S COAIAf}IiATIOM LAWS Oi <br /> CALIrORNIA_' HQtltt>x ADVAM[S FOR AU REOWIED r(�\d�iP-'Etfl�np`Ni AT^1IP�Oi)NS'7J-+12]. Cou�� OMVANG AT LOWER AMA pRD f/ <br /> Sbrra: �1 - TRI. I'�7�t T7 C:L v�-� j}' `f D.1. J Z�1 <br /> ROT PLAN 9).w to 8—W SCH. f I <br /> 1. NAME*Of STREETS OR ROADS . <br /> NEAREST S aK AND P201 THE PROPERTY. t, LOCATION OS NOt18E sEwAOE 018POSAL arETtti+OR PROro6ED <br /> 2. DIME ME OF THE PROPERTY.rY_GLOCA IM OF ALL <br /> AND NM AN OtItECTTON, OKPAMMON OF 8E.WAOQ DI8POSAL WrUFE�1e_ <br /> 7_ OIMENiIOMED OUTLINF8 AND LOGfTRTN OF Ali EXIBTIPRI AND PROPOSED 6_ LOCATION OF V.ELL.A VWT*m <br /> STOMTVM&[MCL-UOING COWLED AREAS SUCH AS PATIOd,DRTVEWAY8,AND WAi1CS. RAORIS 01 ONE HjMD.IFO cs7y ET- <br /> ON THE PROPERTY OR Avio" O PROPERTY. <br /> ... A a............................:.. <br /> j --—, DgARTTrIBiT VSE OMT <br /> p..,t bwpe.tl.n S7 ORB. wnP InPP.eOsn eY D.1. <br /> O..t.veebn b�e.ellen Sr <br /> VJ <br /> D <br /> ACCOUN71040 ONLYt AIDS FAjC f <br /> IR CODES FEZ WPO ANKOUNT RIMUTTED CHfCILi+CASH REC9VEO IS OATS r"'MOTISERMr REOMT xlwgT INVOICE <br /> � 5u z a <br /> Pub.Hesfth Sorv.-Env{ro.173(1/97) <br />