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+ umunTTuryrunErttLIFUMPPERMIT I SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES �� ) ENVIRONMENTAL HEALTH DIVISION { �.o�Cbx 3M 304 EASTWEBEER AVENUE,STOCK ON.Q420MME NT (209( 469.3420 RECEIVED NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED 40V 15 long (C[mphle IN TrfpREaNI J APPLICATION Is HEItE BY MADE TO THE RAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORL DEadme Sad ILIA`` i`aI�Cq!n„E-14 T.y JOAQU,IIN�COUNTY DEV�ELOPMENT TILE.CHAPTER 9.1 116-3 AND THE STANDARDS OF SAN JOAOWN U^+�'1;Pt/BAK IIEALTl18E ��L�� • 'C r,�,,{�, E LYfE11 BAH JOB ADO eonrwri300blDc r!G�{ �. 47r}1M pp I r{33� s rQ N79R111f11?1 c ['y, 'T, +1 V,L a 1-72-3HailFOt cLLm +UC /� PARCEL SREJAPII! L� OWNER'S NAME �� 1 J r GG 1 ADORESg'l� �. CYTO.j o PHONE 0 T�$7 J J CONTRACTOR c�V$MC< ( 41• y11L ADOItEes I�I03 ►MI PL:.� !.#p. S7d: �''I ItiwNF/Y56'Y7.�b` SUS CONTRACTOR 114 1 P S(11yt'r►g A.11113611V pPgjC TTCPSO,/2Q OE nwNE P�O1''T7/;• M$ ❑NEW WELL Cl REPLACEMENT WELL 411 MOW10ISNG WELL'I r�} TO I s ❑OTiiER . ❑INSTALLATION ❑WELL SYSTEM REPAIR :❑CR OW&CONNECT REPAIR .❑VAPOR EXTRACTION WELL s ,J RYPE OF FVMPI 13N—C3 f6p h H.P. DEPTH PUMP 0EY FT. ' FIRST WATER LEVEL O ❑OUT-OP-EfRmE WELL I3 GEOPHYSICAL WELL 1 ❑ EOR DOING E ❑OESTRUCTIOM I NTINDFD V[E TPG OF CONSTRUCTION ipEC{F1CA LONE 1, A 11 INDUSTRIAL t❑1pp OPEN BOTTOM IA.DOF WELL EXCAVATION DIA,OF CONDUCTOR CASING �~ p ❑DOME@TICIPRIVATE C3 ORAVEL PACKIINZIE TYPE OF CABINOWEEUPVC IDIA.OF WELL CASINO �— O ©PUBIPCANMDRIVENCIPAI ❑DRIVEN DEPTH OF GAOVi BEAU SPECIFICATION "R ❑IRRMATIONIAG ❑OTHER GROUT SFAL INSTALLED BY A Wr comet t T' OITOur 011AND NAM! O H�' f N L rKfPA COW MOMTONENG GROUT GEAR PLIMPED;❑Y— [IN. .. COHCRETEPEDESTAL@YDISLLEC❑Y,o [IN. S APPROK.GIVEN 6 f"tJ� LOCKING CHESTER BOXISTOVE PIPE STRVCTIO IMMLU/p METHOD: MUD VOTARS PROroSEp CONY AIA nOTAFRY AUGER_ x _CABLE OTHER !IIE°EeY CERTIFY TlIAT 1 HAVE PREPARED THIN APPLICATION AND THAT 711E WOML M°LL at DONE W ACCORUANCE WITH GAN JOAOUIN COUNTY ORDIHAHCESTE IAN ,STAAWD.AND RULES O REGULATION@ OF THE BAN JOAQUIN COUNTY. HOME OWNER OR LICEPISED AGENT'S SIOHAT URE CERTIFIES THE FOLLOVANO:'I CERTIFY THAT IN THE PERFORMANCE OF THC WORK POR WHICH YHI PERMIT IS ISSUED,1 SHALL NOT EMPLOY PERGONG SUBJECT TO WORKMAN'S COMMRSATIGN LAWS OF CALIFORNPA.'CONTRACTOR'S HIRING OR gU1R.CONTRACTINO SIGNATURE CERTIFIES THE FOLLOWING: -I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(POR WIRCH THIN FERMI►Is ISSUED.1 SHALL EMPLOY PERSONS SUBJECT TO WOAWMAN's COMPENSATION LAWN DF CALVGIMA1' TTH�E APMCCfAkT MUST CALL N"OUIt@ 7N ADVANO@ FOR ALL AEQIARED tPISP[CTIOND AT 12001.604422.COMPLETE DRANIING AT LOWER AREA PRONGED, W".d Till. PLOT PLAN prom to 6°.1.1 6..I. •H0 J I, NAME OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PRO--' S. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED ' 2.OUTLINE OF THE PROPERTY.GIVING OPIAWRIONS ANIO NORTH DIRECTION, EXPANSION OF SEWAGE DlBPOSAt SYSTEMS. , O.OIMENNONED OUTLINES AND LOCATION OF ALL EXITING AND PIGPOEEO E.LOCATION OF WEWA WITHIN RADIUS OF ONE HUNDRED FIFTY FT. 11TRUCTUAEB•INCLUDING COVERED AREAS SUCH AS PATIOS,ORVEWAYS,AND WALK& . ON THE PROPERTY OR ADJOINING Prnp%RTY. .. M tyytF fTLR'.I10 J u 3P t+t I C1,00rz 04000 ,•. 2 to T ... A,T V"9 Srr, �lL;a �O,a,EG Tl�S DEPARTMENT USE ONLY APM°nbn A—pe.d GYDM. 19S-- A— �`I `(\`,`Yl'{ erwrl wwellM eT DN PUnP IMP.°eIM By D.1. ppp b..tru.,l.n IrMpo.t1.,,Rv pnr ' ` _ I `-�\I � ACCOVNYeNO ONLY: Alp/ PEACE ' I PE CODES FEE INFO AMOUNT REMITTED C11Ec 1tECflVED SY DAVE PEP"'T1[I#NCE REOUMT NUMBER INVOICE 00775"Z P I,