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f LIGATION FOR WELIJPUMP PERMIT ( w <br /> SAN JOAOUIN COUNTY PUBLIG HEALTH SERVICES COPY <br /> � ENVIRONMENTAL HEALTH DIVISION <br /> ..304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 ; <br /> IfoIRREF9R0A8LE PERMIT WINES i TEAM FROM GATE ISSUED <br /> (Cmplete M TrlpReatel <br /> APPLICATION IS HERE BY MAOE TO THE BAN I6AGUIN COUNTY FOR A PERMIT TO CONBTRITCT ANDIOR WBTALL THE W01K DEBCRIBEO.TWO ASIC -rjOff 48 MADE IN ANCE YMH SAN <br /> JOAQVrN COTIHTY PEVELOPMEHT TrnL CHAPTER 9-111 S.3 AND THE BTANDAFRW OF BAN JOACUIH COUNTYLIC PUBHEALTH SERVICES.ENMROMMENTAL HEALTH OM810N. <br /> 537 E. t too 4a2 crrY S oG � PARCEL 81ZFJAPHR <br /> .108 ADORES BA]R APN# 4 1,i <br /> , 310 <br />' LeeeLl�+II �ce�liNi 't u�/'�Hs10i+tI` ADLTIE88 �Gvl � .! Gt. l ;Gc"iP►arle.`1����1�g <br /> OVOW11*8 HAME <br /> t � ADORE <br /> i as 400 M.Wt146hW'a uC,66e}�-7 F.IONE.14b�T'to0b <br /> •! a � <br /> CONTRACTOR <br /> ADDRESS LIC# ASONE <br /> RUB CONTRACTOR <br /> TYPE OF WEL_LIPUMA O NEw wLLL © REPLACEMENT WELL MOMTOItlNa wm I b Q aTHE11T <br /> © DIBtALLATgN ❑wat SYBTETA REPAIR ❑ CR088CONNECT REPAIR © VAPOR EXTRACTION WELL# -,j <br /> PUMP 8ET FTFIRBr WATER LEVEL. O <br /> 13 m.m.0 Rm.& - H-P_ , . Q y� <br /> fTYPE OF PUMP! ta Oak BORING <br /> ❑ G1R-OFBERVICE WELL '� OEOP/IYBLCAL WELL. <br /> ©DEBrRIPCTION: <br /> A <br /> !T-VSE TYPE OP WELD CONATRUCHON ePECiFICAT10NS I -� £ <br /> © MOUMMAL El OPEN BOTTOM CIA.OF WELL ExCAYATIGN TINA.OF CONDUCTOR CABRKL D <br /> Cl OCWV ICMMVATE ®GRAVEL PACKtKM 16 3 TYPE OF CAWMl$TEELIPVC 7 V G DIA.OF WELL CASINO O <br /> ❑ F11BWft UT11CIPAL ❑DRIVEN DEPTH OF GROUT REAL d I ?•P- SPECIFICATpN 7 a _ '� R <br /> I] BtluGATIONIAO ❑OTHER GROUT REAL INSTALLED BY?K•1+r1 ltil ; ORDUT BRAND NAME d? d <br /> Q f <br /> ® IevNrrORfNO I f GROUT SEAL PUMPED:®Yr. 13". CONCFWM PEDESTAL BY DRILLER O Yr ®IN <br /> /Bs <br /> APPROX.DEPtH b T1 I Q LOCKING CHESTER BOxroVE PIPE '^ s <br /> it OTHER <br /> PROPOSED CONSIMMTIONRMMUMO METHOD: MUD ROTARY AIR ROTARY AUGER _CABLE <br /> i HEREOY CERTIFY THAT T!LAVE PREPARED T}96 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WallAH BJOAOUIN COUNTY OROINANCE9.STATE LAWS.AND RULED AND <br /> sUOULAT10N8 OF THE SAN JOAQUIN COUNTY. HOME OWNER 011 UC"MED AOEIlT'S SIGNATURE CERTlFiEB THE POLLOWMAT:-1 CERfiF'Y THAT HI THE PfRa'OfeulARaCE OF THE WORK FOR WHICH <br /> THM FERMff IS mgUED.I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAW8 OF CAUFORMA.' CONTRACTOR'S WRIM OR WSICONTRACTING SIGNATURE CERTMES <br /> THE FOLLOWING: 't CERTIFY THAT IN THE PERFOIMIAHCE OF THE WOW FOR WHICH'Me PERMIT to ISWED.1 SHALL EMPLOY MOM"MAjECT TO WOPIKMAMS COMPENSATION LAWS OF <br /> CALIFORNIA.' THE APPLICANT MUST CARL 24 HOURS IN ADVANCE FOR ALL RMOUIRED M1NSFKCTIGNe AT(20614eea+I2L COMPLETE ORAWINO AT LOWPRO <br /> V11". <br /> AREA PRV11". <br /> O�a Ft �dOl ��IYP r — _ — -q 9 — <br /> B�x o«. <br /> _ PLOT RAN IOFB is 9*11W Se.N <br /> t. NAMES OF STREETS 011 pOA68 NEAREST 70 OR BOUNDING THE PROPERTY. t. LOCATION OF HOUSE SEWAGE OTSPOSAL SYSTEM OR PROPOSED AITI <br /> E NI . <br /> . ANeRON OF SEWAGE DPOSAL eYMfEMI. I <br /> !. GUrUWE OF THE PROPERTY.G1VMCMR7 OSNEHBIDNS AND Nom"O ECT10N. U PExPD1r Of WELLS NSTILIN 11ADIUe OF ONE MlNb11ED igRV FT.! <br /> ?. 011MU eIDNED OVFUWI AND LOCATION of ALL Exwr*n AND Fr1OPOfEO ON THE PROPERTY OR ADJDSaNR PROOF ON. <br /> 'BTINICfVRE6.eL41ON10 COVED AFEAS SUCH As PATIOS.fM <br /> MVEWAYS,AND WALKS. <br /> E ...... ....... ... <br /> ......... ..... <br /> - - - _ <br /> - - .. .. <br /> f <br /> : <br /> "DEPARTIMENT.USEOHLY <br /> Appft 11 AOowMd BT <br /> .. - Deis <br /> O..x f+oaetbn BY - D.n Rfn♦hroreelan fit .. Det. <br /> Oenwnlen Gwv.ce6m By Dw. <br /> ACCOUNTING ONLY. AID# FAC# . <br /> PE CODES FEE INFO AMOLWr REMITTED CHECK#1CASH REC8VED IV DATE -. F9MeITN814lCE REOIPEST NUMBER INVOICE <br /> 1 <br /> Pub Hea"Sm.-Enviro.173(1197) <br />