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03-23-2000 09 25AM FROM TO 17079356649 P 02 <br /> APPLICATION FOR WEMPUMP PERMIT " <br /> F SAN JOAQUIN COdNTY PUBLIC HEALTH SERV--.e$ <br /> ENVIRONMENTAL HEALTH DIYIS1011 <br /> P O BOX 988,3D4 EMT WEBER AVENUE,STOCICTON,CA V_M-988 <br /> 12091"li.2420 <br /> • X(lWAFfIJIX0A itt PERMIT EXPINES 1 YEAR FROM DATE 133 - _ <br /> 1Eemp6b Is Tr}liub! f i1- L J °�I�2 5? <br /> APPLICATION 19 HERE BY MADE TO TNF CAN JOAOUIH COUNTY FOR A PERMIT TO CON9TTUCT ANDAGII INSTALL THE WOW DEMCRIBEO THM APPLICATION 19 MADE IN COMPUANCE WIT"SAF <br /> MAOURN CDUNTY OEVELoPMEW TITLE CHATTED 9 1115 3 AND TME GrANDA7V/OF SAH JOAOLIRN COUNTY T4)BLIC HEALTH SERVIOEB ENvMONmENTAL HEALTH DME10% <br /> .100 AODREBE/DR APN/� L] �,1,�^ C_-A.r .c....-��1 A �C1TY S+D C_k-6 Y-, PARCEL SIZUAPNF <br /> ADUArec P.A b F c 6 t Yg,�, C� �•.n_ 64 �]� L srlDrn r <br /> COUTOACTOII AOOKBI • 0 i 5 I lA ucf PHONE iZA3_lZE_y91k <br /> tvscoNrRNcro*,y�,f_C� �� ^7 _ADDREsa9Sb Alm ,. Ad PHONEEfar.bT-d-4a6 <br /> TYPE OF VOTU.0PUMP• ❑NNm cu ❑11ERACFwmuy MIELL ❑MONITORING WELL r ❑OTHER � <br /> ❑INSTALLATION Cl WELL SYSTEM MrAW Cl CROB&CONNECT REPAM ❑VAPOR EXTRACTION WELL! J <br /> 13 Na❑F1.P.4 Hp DEPTH PUMP SET FT FIRST WATER LEVEL O <br /> RYFF OF iR1MN <br /> ❑OUT-OF"mwE vA%L ❑oEOFNTtICAL Wtu 1 �FbIL SowFM_Ll A-Y�s,s B <br /> ❑DEMNAC w so- Soy <br /> HNTFNDED E T+E OF mm Dm*j;UCTH)N% CIF,CATION A <br /> ❑INOLMRIAL ❑OPEN BOTTOM DIA OF Wt"tACAVAT/ON MA OF CONDUCTOR CASINO D <br /> ❑DOMEsTIC/PNVATE ❑GRAvtt PACTLm t TYPE GF CAWNGAFTEELMVC DIA,OF WELL CASINO D <br /> ❑PVWUMUMICI►AL ❑,, / /3 <br /> DFOVEH DEPTH OF GADUE 14AL D/[CMICATION R <br /> ❑,�/NRBM <br /> 1ATION/AG L7 OTHER e- .yoi4URI <br /> r sEAL FTALLM ST GROVE AMf <br /> NO NAME <br /> Ly MONrlopwo0 GROUT SEAL PUWFD6❑YM ❑N. CONcmETFPEDEtTAL6YDTaLut0Yr ❑N. S <br /> APRROX DLPYRS S'(>- Q 0 LOCKING CHESTER BOx/frow RPE �Q s <br /> PROPGAW CONBTDUCTIO%lfflM MO METHOSE MUD ROTARY MR IaOTARY AUGER CABLE OTHER �„V c. rA 6e <br /> I HEREBY CEWRFV THAT 1 HAVE MWPAIED TM1 A 4N-PCATION ARID THAT THE WORK WILL OE CONE IN ACCORDANCE WTrH BAN JOAOUIN COUNTY O"D1NANCE9 STATE LAIARS AND INLEC ANC <br /> MGULATTONS GF THE/AN JOAOUN OOUNrV HOW OWNER OR rJCE'P MO A*f W B MGNAYUFE CERTINEG T49 FOUOW Wp I CFRr1fY THAT IN THE FFTFORM/MCE GF THF WORK FOR WIOU <br /> THIS PERMIT U9 TBBLKO I*HALE NOT EMSLW PERBONd SUBJECT TO WOhKmRw4r cOMPSSTBAMN LANE OF CAUromm . CONTRACTOR B)"RUNG OR 8UlCOFlIMCTINO 1MNATUK CERTIFIES <br /> THE FOLLOWING I CtRYWY THAT W TOE PERF071MAHR OF THE WORK FOR WHICH THIS FE:FTJRT M LOVOCO 1 SHALL EMPLOY PERSONS 1IJSJECT TO WOIHIFA M/COMPID—TIOR LAWS OI <br /> CALWOI1DA 7HF V1T CAEL.SE NOU11S 1N AOVAIICE FOR ALL KOARFD SHIRK name AT pool+IISJ 23 COMPLETE DRAYJMNO AT Low"AREA PROIRDED <br /> ((f�I/ <br /> B,9r 1[ /�4(/f.Q.�__ THI. <br /> PLOT RAR fO.N r Re.I.I Act. is <br /> INAMES OF 1771[ETS OR R QAOS NEAOtST TO OR IOUNDINO THE PROPERTY • LOCATION OF NDVOE UWASE ONBPOBAL SYSTEM ORT. <br /> . DP IFED <br /> EOUTLINE OF THE RIOPE/TTY ORVPHD DrWNMNG AND MF <br /> MiHTH DCTLON fXPANBION OF EEWADE DISVoTIAL/YSI <br /> TEM <br /> S WMEMMMEO OUTUNES AND LOCATION OF ALL EXWTNNO AND PIO POGM t LOCATION Of WELLS WITHIN IUDRFO OF ONE HUNDRED FIPRY n <br /> STIRUCTU 1X_%INCLUOING COVEMD AREAS SUCH AB PATIOS O7IVFWAYS,AND WALKS ON THE P oPERry OR AOMRFwO PMPEgw <br /> Rpr-PF ✓ B <br /> LL <br /> 'WPARTMOIT USE"T <br /> _ a �` s•" v <br /> A.PAea11Rn Ar.PNd PY ` DK. 1Mr <br /> O'P W".v n By DMS P—P InFlrsen By 4 r 1+-� DMf <br /> DwV.TII.n Iw vl1 BV DMP <br /> C.— WOL&AV Ailt `5 �T7 � Q �/�PVA-C'� L✓ <br /> • AetOLwTIN60NLY ANbr PACE <br /> K COOSB Vol INFO A•AOURT„TTIBT]t0 c-IM"KAEN RIECOVFy ST DATE rrA%9Tj09MCE H(GUMY NUJIIM INV07CL <br /> TOTAL P 02 <br />