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APPLICATION FDR YYELLfPUMP PERMIT <br /> —'SAN JOAOUIN COUNTY PUBLIC HEALTH SERM S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P O BOX 988,304 EAST WEBER AVENEIE,S'1'OC"014,CA 95201-388 <br /> {2091 4SM20 <br /> NUMERABLE PERMIT EXPIRE!I YEAR FROM CAWS ISSUER <br /> Mm"but In TrIp6mal <br /> APPLICATION 10 NERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A PLTMATT TO CONSTRUCT AWMR INSTALL THE WOR WaCRISED THIS APPLICATION It MAGE IN COMPLIANCE MTH BAN <br /> JOAOVIM COUNTY DEVELOPMENT TITLE CHAPTER 6 111 IS 3 AND THE trANOMDt OF SAM JOAO^COUNTYCCT HEALTH SERVICES ENVM NIMENTAL HEALTH OVISDH <br /> JOB AAODWSSIOR APNa I1/ ,4 r N N'C CRTY/y, ,J 47e ? PARCEL SIIJ . <br /> OWNER•NAME L �![ AapREn L''+ �Ctl�Xan 51s CkE/u.�,(4 PHONEF470891-367l� <br /> �f <br /> CONTRACTOR zef,- SS_oN! ADp11EgZ« LJ, (bnkc4c. At LICA 990b PIIdIE/kms+ 3'li <br /> Bus CONTRACTOR_ �LCs �. flsso c ADDRESS I r ucP I, I <br /> 9 <br /> LYJOF ma61glmp. ❑NEW WELL ❑REPLACEMENT WELL ❑MGNToeNK WELL 0 ❑OTHER <br /> ❑mimaATION ❑WELL(Yarm RETANA ❑eRosscotmamm IE►AIR ❑VAT'OR ExrRwTum WELL• J <br /> I]N.w ElR+.Y H P DEPTH PUMP BET FT FMfr WATER LEVEL O <br /> RYPE Of PUMry CI� <br /> 13ouraFsumcEWELL 13GEOnnoeALWELLP $� BOILSORN/p 75" //-w _h'e'r • <br /> ❑DeST wemN <br /> T Dm M TyroN I FISPICIacan�Na A <br /> 13INOMMAL ❑OPEN BOTTOM DIA OF WELL EXCAVATION DIA OF CONDUCTOR CABBIo_ !� Q <br /> ❑DoMES r mvATE 11 GRAVEL PALSUSEE TYPE OF CASINORTEELI4VC4/I --77� dA OF WELL CASINO D <br /> 11PUKXAAWSCIPAL 13 DRIVEN DEPTH OF GROUT SEAL 100 fK�FECIFICATION .,-74- / R <br /> ❑I�IR IGATIOWAG OOTMA OROUT SEAL BmALLEOTIRILIY Tira•j� ORDur BRAND NAME�F1r1o11CLPa T SL4rr�. e <br /> P'1 MDMromm �}/� ��77 GROUT RAL PUMPED vM Y_ ❑N. caNcllErE PEDESTAL w oFv LER:❑Yr 13N- ' B <br /> APPROX DEPTH 2A/ I 1411 11 2:(/ LOCKING CHESTER soxl/roWE LIVE Ai a <br /> HIOP'OSM CONSTIIUCTIONAMLLNO METHOD MUD PIOTARY ABR RDTARV AUGER ^ CABLE OTHER <br />' 1 HEREBV CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THS W.."WILL BE DONE IN ACCO..t WITH SAN MA.CDUAY pIgNANCEt STATE LAOIS AND RULES ANO <br /> REWLATIONS OF THE SAN JOAQUIN COUNTY NOME OWNER OR LICENSED AGENT B S INATURE CERTIFIES THE POLLOWN40 R CERTIFY THAT SN THE PEIMORMANCE OF THE WORK FOR WMCH <br /> THIS PERMrf IS ISSUED I SHALL NOT EMPLOY PERSONS tUbACT TO WORKMAN 0 COMF6ISATLON LAWS OF CALIFORNIA CONTRACTOR■"FARM OR q16{OWTRACTB 0 WMATLR S CERTIFIES <br /> THE FOLLOWING I CERTIFY THAT IN THE PERFORMANCE OF THE WOR POR VASCH THIS PERMIT M AWED I SHALL EMPLOY FERISaKS SVRRCT TO WORKMAN S COMFiNBATION LAWS OF <br /> CALg4MWl APPUCART MUST CALL URS NI AQVANCE FOR ALL FtFOUN{®IIFSFSCTIOISS AT 4201114444 4" COMPLETE DRAWING AT LOVWR AREA PROVIDED C <br /> 14"K Thl._� <br /> PLOT PLAT Mv—N so"faN. 1. <br /> I NAMES OF STFIM5 OR ROADS NEAREST TO OR SOUNDIM THE PROPERTY 4 LOCATION OF HOUSE SEWAGE OFOOSAL SYNrFM OR PFKWOBW <br /> E OUTLINE OF THE PROPERTY GIVING DIMENSIONS AND NORTH DIRECTION RXPANSON OF SEWAGE DISPOSAL SYfTEMG <br /> 3 OIMENSONED OUTLWFl AND LOCATION OF ALL EXIfTBIO AND PROPOSED S LOCATION OF WELLS WTrWH MOUS OF ONE HUNDMO FIFTY FT <br /> TUTIES INCLUDING COVEREO AREAS SUCH AS PATIOS DRIVEWAYS AND WALKS ON THE PROPERTY OR ADJOINING PROPERTY <br /> 1995 <br /> N PlERR4 n SERVICES LTH <br /> r <br /> 1 <br /> I <br /> Ot•ARTMBFT USE ONLY I <br /> A.Ps..tlNn AesNRM BY D.I. Aw <br /> A' _ <br /> G�«A i�psllen Br OSA. Ra.P MnP�IN.'+11Y D.Is <br /> D.N 0-N"-cm n BY D.I. <br /> ACCOUNTING ONLY AIOa FACE <br /> PE Coop FR LIMO AMOUNT R6ARTED C ICAM" ftWBVSD ST DATE PIISMTA Frocs MQUEST NIBWISl1 Mvp10E <br /> V <br />