FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR WELLIPUMP PERMIT r N JOAQUIN COUNTY PUBLIC HEALTH SERVICE ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468-3420 Rom-mEyuNqAvjE PERMIT EXPIRES 1 YEAR ROA[011SUSUED IBRKyIR1R M 7tv"emI11 ATLICATloN M 1KR SY MADE TO INE RAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR IIIBTALL THE WOW MrrCNKEO.110/APPLICATION M MADE M COMPLIANCE WHIP SAN JOAaLRN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAMIN COUNTY PUBLIC IIEALTII WRVIOTS,"W'"OHMEMAL HEALTH OMEION. 'j T JOB AOOM0e10n APNN X 23 •- M it d i l tl inf 5)""11. -- _cm 510 clO PARCEL MZEIAPNP 3 00 r 1)00 --- OWSIEII'S NAME G1164r [+I tv0,01 `,s H,eI Mann S<1r1,f1 ADORES.'/b 3203 W, t'-eh M. DQE erll -low# •, CONTTURCT0IU JvaAt r4�11Lf�Y 111a AD111uUC/ eB4065 V-W1If0N W11 60-. PIONEE`'167'1004 sum COWAACTOR �-T F� ADORES LION ALONE YPE / TOF NIELLIPUTAPU D NEW WELL ❑REPLACEMENT WELL 0 MaNRomm WELL P ❑OTHFR ❑INSTALLATION ❑WELL 9"FEM REPAIR ❑CROSS CONNECT REPAIR ❑VAPOR EXTRACTION WELL/ J CI N—0 P P.h H.P. DEPIlf PUMP SET FT. ASST WATER LEVLL O D YFE OF PUMA Ij OVT-0RSERVICE WELL D OEOARYSICAL LVELL P 19 SOIL BaNHG S D DFOIIRICTION: NI[MDEO iE YP D Cb !TR ON SPECIFIC 10 r1 A ❑INDUSTNAL ❑OPEN BOTTOM LRA,OF WELL EXCAVATION _ _ _ DIA.OF CONDUCTOR CAB" D ❑DOMERTICIMVATE ❑ORAVEL PACKMEE TYPE OF CA8M0I8TEELR'VC 4� DIA,OF WELL CASINO O ❑AXILNC/1FUNICR-AL ❑DRIVEN DEPTH OF TIMID SEAL T.V• SPECIFICATION �' S ❑SRNOAIION/AG ❑OTlIER O"OUT SEAL INSTALLED 1Y GROUT BRAND NAME Per71• C�E 1�a E R"OMTONNO A GROW SEAL PUMIEOT 0 Vr 13N. CONCRI TE PEDESTAL RY DNLLEII;❑Y.a WHA S APPROX.DEPTH E b - -- - Lo"ING CONOVER sox/1NOVE APE J �y1 P L s PROPOsFo CONsIRUGHORMMIINO METHOD,MUD NOTARY AIR ROTARY AUGER CABLF. OTHER a'w,GI •Uf'{ I HEAENY CERTIFY THAT 1 HAVLI E PnEPAWO TIRE APPLICATION AND THAT TILE WONT WALL If.DONE W ACCORDANCE WNT IIH RAN JOAQUIN COUNTY 0ROINANCE1,STALE,AWB,AND RULER AND ATIO moulNs OF THE SAN JOAOIIN COUITrY.HOME OWTIER OR LICENSED AGENT'S BIONATURE CERTIFIES THE TOLLOWXNO:-P CERTIFY THAT IN THE 417WORMANCE OF THE WON(FOR WIMCH THEA PERMIT IB ISSUED,I SHALL NOT EMPLOY PERSONS SIJSJECT TO WORKMAN'S COMPERFAIDON LAWS OF CALRORMA.-COMRACTOWN"WHO OR*USCONTRACTRIO SIONATURE CEITINER THE FOLLOWNIO! 'I CErTTIrV THAT IN THE PERFORMAIICE OF TETE WON[fOR WHICH THIS PERWt IB ISSUED.1 SHALL EMPLOY FERSONS SUBJECT TO WORKMAN'!COMPMGATMIO LAWN OF CALWONAA..-^T,H.E APPLICANT MUST CALL 24 41011110 IN ADVANCS FM ALL REGUNWID IPSCrIaNs AT I2061 48244x0,COMPLETE DRAWNO AT LOWER AREA PROVIDED. Rlerodx f `L /.'ClV'If�V"V __TRr.5441E1, '51(1{ 'Ute i ►LOT RAN ZZ N S..I.1 Sed. -1. 1, NAME11,s11EETS OR IIOAOS NEAREST TO OR ROUND"THE AgIE7RY. 4.LOCATION OF 14OVIE SEWAGE DIRMNAL SY1 FM On"M OSLO OUTLINE OF TRF PROPERTY,OMNO DIMENSIONS AND NORTH DIRECININ, EXPANSION OF SEWAGE DISPONAL B"TEMI. Z.D MENWONEO OVILMFS AERO LOCATION OF ALL EXISTNJO AND FIIOPONEO R.LOCATION OF WELLS WITHIN RADIUS OF ONE IIUNOTWO FIFTY R. STRUCTURES.INCLUDINO COWSED AJEAB SUCH AS PATIOS,DRIVEWAYS,AHD WALKS. ON T11E PIROPE1rtY OR ADJOIHNO PROPERTY. C 5 til Le L DEPARTMENT URE ONLY APPNa.lhe Aa. wd NY DH. Mr fh.u1 IrwpeeP4n ST 0.1. P—v h.a.A.O.n 1Y b.l. On.Rn.vRl.n h�n.efler,RF fm. Cn•n,nwM.: ACCOUNTING ONLY; AIO/ FAC/ PE COOr's FEE INFO AMOUNT ITRITIED 11 /CASH RECEEVEO■Y DATE PFISNIrls;HNCE REauts?NLANSI I f f"fes SS3 SS sZ V2Zl Pub.Health SNrv.-EIIYUD.173(1197)