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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES PAYMENT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> • P 0 BOX 388, 445 N. SAH JOAQUIN ST., STOCKTON, CA 86201-388 RECEIVED <br /> (209) 488.3420 NAY 10 1n.15 <br /> 1 NODI REFUNDABLE PERMIT EXPIRES I XEAR FROM DATE 133 DSAN jl)A+ It 17)' <br /> El ICalapUd la 7Tipllsat.l PUBLIC <br /> }�� f+.r <br /> pPLlCATIOk IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMR TO CONSTRUCt AND/OR FN{TALI.THE WOroC DESCRIBED THIS APRJG1Y 116 MK�II�IytdjAP .t .'yVi'yPf=6AN� <br />' �AWIN COUNTY OEYFLOPMEN7 TRU CHAPTEA 9-11 15 3 ANA THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SEpMCES CWARONMENTAL HEALTH tXMVION <br /> 3a AOORESB/OR AP}1f I43 �_;j%�}_f J CITY / PARCEL SIZVA►Nf <br /> %"CR b NAME 6 lO�+'4! v�L/ L/ `-'7 n v 12140 Ni f —I <br /> 7NTRAC'TOR f Cl ✓f Aaontaa/ `�iu�0. �i4f7 \70fG <br />' <br /> is cDNTRACTOR��T�.��C.�,s }�p .C�f � SNE f f�* � o�� <br /> LCL(1.ie�.�c�rJ �Z._, �._ADDRESi.. d- 2-� u,� PHONIC I JfO Z. <br />' 9E OF WEudrumP ❑ NCN WELL ❑ REPL,Ac MENT VML �MONITORW6 WELL f- ❑ O'm^ <br /> ❑ iNSTALLATION ❑ WELL SYSTEM REPAIR CROig-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL J� - j <br /> 'pe OF PUMPF Q NSW W Asorr H P DEPTH PUMP SCT FT FIRST WATJR LEM p <br /> ryry <br /> C3OUT-0E-BERVICF WELL E3 OEOPHY{ICAL WELL i aalL aOWNo B <br /> OEtTTRUCTION / 1 <br /> T U>f O W CONSTRUCTION iPSCIFICA Oita <br /> �. � /I,/] A <br /> INOusrRIAL ©OPEN BOTTOM aA OF rVEti EXCAVATION dA Of cDNDUCTOlI r,AetNo /Ir/�7 D r+ <br />' I Dd1.[E9TICRRtVAT! ©GRAVEL PACICrgIZE TYPE OF tASING.'S'TEEtJPVC DtA OF w�LL t:.s.91Nq � Vy <br /> 7 s'u6LICA.tUNICtPAL ❑DRIVEN DEPTH OF 9ROUT SEAL 1 SPECIFICATION <br />' 'RPIOATMNIAG ❑OTHER GROUT SEAL INSTALLED BY �" GROUT BRAND NAME �C f <br /> l MONRCRING y J _ OAOUT aEAL PUL4Pip Y. ❑No CONCRETE PitmurAR BY DIVLLEFL w ❑Na S <br /> ++�4G% DEPTH GJ LOCKING CMJ$TER&OXIVTOVE PIP!_ s <br /> IOPOAM CONATRUCTION446WNC F,4rrHOD MVO TARP AIR ROTARY AUGER CABLE— 1// OT}ICR � <br /> By CERTIFY THAT I HAVE PACPAMD THIS APPLICATION AND THAT THE WORK WILL BE GONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAAlC>r14 STATE LAWS AND RULE{ANON <br /> LATION9 OF THE BAN JOAQUIN COUNTY HONE OWNZA OA LICENGF0 AGENT 8 91ONATURE CERTIFIES THE FOLLOWING I CERTIFY THAT IN THC PERFORMANCE OF Twk WORK KOR WHICH <br /> VS PERMIT 15ISOUEO I SHALL NOT EMPLOY PERSONS allBJECr TO WORKMAN{COMP04SATION LAWS OF CALIFORNIA- CONTRACTOR'S HIRtNO OR 6U3.CONTRACTF4O SIGNATURE CERTIPIEE�, <br /> Of FOLLOMNO 'I CLATIFY THAT IN THE PI;APOPMANCE OF THE WORK FOR WHICH THIS PERMIrr IS ISSUED 18H!ALL CMFiPY PSRSONe gUCIJECTTO WORKMAN OOMFOI{AT10M LAWS OP <br />' AUFORNiA ` <br /> ' CANT MUST CALL 14 NOU K&IN ADVANCII FOR ALL ASQLARC f TION{AT i2OP1 COMPLLTC DRAWING AT�LOVAFA AREA N 6 <br /> oats <br /> 1L0 [Draw e4 864441 80614 'to <br />' NAMES OF STREETS OA ROADS NEAAEST TO OR BOVNOINO THE PFvOP9EM Y 4 LOCATtON OP HOUSR{EWADE DISPgSAL gYWMPA OR PROPOSED <br /> OUTLINE OF THE PROPERTY,01VIN0 OlmeRl IgNg AND NORTH DIR[Cf10N EXPANSPON OF SEWAGC CISPOSAL SYtTTIMB <br /> t?IMEN&ONEG OUTLINES AND LOCATION OF ALL,Uc15TIN0 AND Ff1pROtiiD 4 LOCATION Of WELLS WITINN RADIO{OF ONII HU qo"W FIFTY FT 1 <br /> STRUCTURES,INCLUOW4 COYEACO MEAS SUCH AS PATIC6,DRIVEWAYS AND WALKS ON THE P"OFsLIRTY OR ADJOfNtNO PROPgM-e <br /> DEYAAT74AiTlT 1lSK ONLY <br /> *dcatbn Aro6Q16tl BY <br /> DK4 � Anr <br /> owl ln.p6ollon{r A41 <br /> Pw*o Irop6oUon Br Data_ <br /> �.wtlon!n•P7atbl+Sr <br /> I <br /> OUNTINO ONLY MDI <br /> FACE <br /> i+[{ <br /> COCA FCC INRQ AMOVNT RVA)TTIND CHEICKWCAfH AEC BY <br /> DAT F6tfiYr/14iRbICt RSOt1R{T NumuR wVOICS <br /> I S <br />