Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> (209)468-3420 <br /> MOB REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (CtMPIMS M TI1,1E.It) <br /> APNICATRM M NESE er MADE TO TEST MN JOAMIN COUNTY FOR A PERMIT TO CONSTRUCT ANOgR INSTALL THE MEN DESCRIBE..THIS AMMATKIN le MAD:IN COMPUAWF MTfN BAN <br /> MAOU N COUNTY OfVELOPMENE TITLE,CHAPTER B'111 5.3 AND THE STANDARDS OF SAN MAW.COUNTY AIBLM HEALTH BERVItFe,fNNIgNMFMM MALT"WIFON. <br /> MBAoovem AR # a5q 4� Pl ymoudA c— stockli <br /> WtrAPANCfL NiElA1W/ !d3 -GELD-Y.� <br /> DHFTENAME JT &,,uIA.f.HC( /� J AGGRESS Jgkv.O-. FROM, <br /> COMPACTOR Et4,vlrot ],NL ADDEIN P,QIRox 4259 M. FROM/)02FD SW <br /> Bus coMRAcroR P1 �J Uhl lll�Q AODPEEE M hfovx_Rd M.01196— <br /> EC. 0H l65 AAM,5/0-313�boa <br /> Im OF M'um,owA pl NEW WELL ❑IIEAACEMEM WFII ❑MOMTONNO W[LL.ALUI.6 O OTHER <br /> ❑METAWTMH ❑WELL EWTEM PEPPER ❑CMASB .INFCT REPAIR ❑VANS,EXTMCTMNWf1E.I, J <br /> (3N.x O11pW H.P, DEPTH AIM,Sir IT. ' f WATF11LEVM p <br /> RYN OF AIM% <br /> ❑OM-orIt.*ma 13Om.NH,.MW4LL, ❑ MS.WNW S <br /> ❑OFBTRIICIMN: <br /> )MENDED —CONE-7-71170-7470—USE 110 a F A <br /> ❑ BIA <br /> INWAL ❑Om.worMLE DIA OFMU.EXCAVATMN O, DEA.OFCOMHICIORCASgO N/l- p <br /> ❑OOMEMMOWVAE JzI DRAWL PACK/MIT TYIF OF CAARIIEELPA` .E 'YV ` DEA.OF WLL C <br /> TANW p7.FF O <br /> 11HNIMANNTIPAL ❑INDIM MRH Or..Hr REAL A 1 1-.' EACRICMMN R <br /> L3........ ❑OTHER ORODT SEAL METAU ED eY DYIIUW gMH.FAMNAMF E <br /> 0 MONITORING .MOT BEAL MMNO:Q Yes ®N. CON[MFTF AOEAM WDRIER®Y� QN. 4 <br /> Al1 <br /> AoR.DEPTH N LOCRIM CMrtFM MXRTOVE A14�0.Ntf DOx S <br /> MOMMUS O."IFENOTIONAALUNO MANGO: MM WT. AIR.TANV AUDffl_)CASLE OTHER <br /> I HENRY CIMIFY THAT 1 NAVE RRFAMD THIS M AT.N AND THAT THE WGA[IAML SE DOM IN ACCOMAME WIT"SAN"AWN COMITY ORANNAMES.'ATF LAIN.AM RLE.AND <br /> REOIMTIONB OF THE SAN MAWIN COUNTY.MME OLMIM OR MENBEO AOEM'.MONATUFF CERTIFIER THE MLLOWTNO:'I CERTIFY THAT M TM MWOAAAME OF THE WORN MR NMICH <br /> I <br /> THIS PEROT IB IBSUM,I"ALL MT EMPLOY PERSONS SUBJECT TO WORWAN'SCOMPENSATION LAWS OF C MIMANA.- CONTRACTORt HINM OR WEOATATWO MONATUM CERTIFIES <br /> I THE FOLLOWING: -1 CEANY THAT IN THE PENOMAME OF THE WORN FOR WM.H THIS MPMT IB RMJFD.1 BRILL EMPLOY ARSONS tUILIECT TO WORRMAN'6 COMPENSATION LAWS OF <br /> CMNORRA91 <br /> .'' THE AFR���EEE.C,IANT MUST CALL M MMES IN ADVANCE FOR ALL ME ft ISHIIM�CMNMI <br /> S AT IE ..tA <br /> 41422.COMEMW'I <br /> )[OM AT LOWS.AMA 1'MNOEO. <br /> ft—IA 91Am .4 HE. YJ!J'ec7L-QCo_q/)r <br /> / MOT RAN P-1.%AAA S.*_'N_ <br /> 1. NAME.OFSTMFIBORMAOBNEAMBTTOOR.OUNOMOTIIEIMMM . A LOCATION OF HOUSE WMAOE gBM.M BYBAM On HSHORD <br /> I. OVFLINE OF THE AINERTY,OINNO DIMENSIONS AM NORTH DIRECTION, fArANB.N Or.M..9 DBMBM EVEMMI. <br /> ]. DIMENSIONED OUTLINES AM LOCATION OF ALL EXNHRID AND FWMMD E.LOCATION OF MU.WRINN SAME OF OM WHOM0 HIM IT <br /> STRUCTURES,MCLUDIM COVERED AREAS SUCH M PALE,gEVfWAYS.AND WALES. ON THE PMMREY OR ADJORIM ROMM. <br /> 6 c lea ^I <br /> 5t. PJevr"v ud¢tM 5 mW-6 <br /> L�L4VLL�1 s <br /> dg I <br /> COULAAj ty CALA:6 glud <br /> A.W..IIm AN.F1.E ST •!'I`l'k"'7` DVARTMREr DtF ONLr Dx. {4''Lr/ I.Y/ wr V�L-J.I... <br /> m.M B.em1NR er lJ oN. wAP II....1w,eY oM. <br /> Dar,..II.,Ir.p..Im <br /> or <br /> oflpsvk WorIC Ln Loa 6l <br /> i <br /> ACCO.NTR..-I: ARM FAC/ <br /> M EWASS FFFIMO AMOUNT FRMTTEO CMCR,MMH Rmmw.Y DATE FRNATI.FMICE REQUEST NMI. RAVMF <br /> b 24 (o I 122}-R b l l Z/o <br />