Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.sox aft 304 MT WMER AVEMIE.sTOCKPDK CA ss2oi�es <br /> 12801468-3420 <br /> X014REFURGII LE MI RE I V FROM OAT sill ,? .. •! n I <br /> rGemploto <br /> APPLICAYwN 16 HERE DY MADE TO YME IAN GUSI JOACGUHTY FOR A MIBUR TO CONSTi1UCT A TNOMR W FrALL THE WOAK DE{CRISM.TMp APPLIC,hTIpN 1>< �E <br /> JOAGURI COUMV OEVELOPMENT TrT E�CHAPTEIL 9-11114,S ANO THE STANDARDS OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENYNIGNMENTAL HEALTH OMMION. ��EE ' <br /> P y <br /> JOG ADDRESMIOR II <br /> CT' PARGLl&2F1AP7i. �+�,� <br /> OWAIE11Ti NAMEL.. 1--,� <br /> COwRACTOR"IJ21 ICSH C�lof �1 r ; '..--�—; ,. f ImE <br /> ADDRESS <br /> ONE; <br /> BUB CONTRACTOR <br /> ADOIIF� lam/ RHONE• <br /> TyMgt MdLIrImp. ❑❑�NEwvwu ❑REPucEAIENr wE11 O MONITORING wET.LB 13O7nEA <br /> C�ukrtJ MBTALLATION E3 WELL Bmtm REPAIR ❑cmus CONNECT MEPA4R 13VAPOR EXTRACTION WELL/ <br /> C7 N.w 13F P.b HA,�— ! J <br /> [TYPE OF MMPI DEPTH PUMP SE7�PT. ' FIRST WATER LEVEL� d . <br /> [ ❑OUT-W-SERVICE WEIl Q aioFNYSICAL WELL/ Q OWL BORING a <br /> ❑DESTRIJ mpe <br /> DTy"Or wair COMPTRUC119" <br /> rf�yR e , <br /> L.[SIbUBTIBAl ❑OPEN BOTTDPA <br /> DIA,OF WELL EXCAVATION VIA.OF CONOIA:TGq CABITIO O <br /> )ErDOMESRCARWYATF ❑GRAVEL PACKISLTE TYPE OF CABINOATIFEUPVC DIA.OF WELL CASINO <br /> 13 PUBLICIMUK'NMAL ❑DRIVENO <br /> OEPnI Ci GROUT 6EAL SFECIFICATRON A <br /> OwwATKIIIIAG 13 OTHER GROUT MEAL INSTALLED BY OROUfBRAND NAM <br /> E <br /> 13 E <br /> MaNRDf1FA GROUT REAL PUMPED:❑V- ❑N. CONCRETE PFOESTAL BY DIVLLER:❑Yw ❑N. a <br /> APPROX.DEPTH LOCKING CHESTER BOIUSTOVE RPE <br /> s <br /> PROPOSED CONSTIIUCTIaNfGPLU1N0 METHOD:MUD ROTARY AIR ROTARY AUGER CABLE_ �OTHER <br /> 1 NEAEMY CFJTTM*/THAT I HAVE PREPARED Tfd6 APpLICA7ION AND THAT THE WORK WSL BE DONE IN ACCORDANCE WITH MAN JOAMW COTMTY ORDINANCES,6TATE L,AWs,AIA R[MEM AND <br /> PEaUUT10N6 OF TINE BAN JOAOUIN COUNTY, HOME OWNER OR LICENBED AGENT'S MIONAITRE CERTEIEM TIE FOLLOWINOT'R CERTIFY THAT IN THE PERFORMANCE OFTNE WORK FCR WHR:H <br /> THIS PFRAIIT IM IROM,I ON ALL NOT EPA PLOV FERBON9 SUBJECT TO WORKMAN?COMPONIATIOR LAWS OF C�WFORISA.'CGNTPACTGR'MMVKA OR?lI1M�ONI{IACTAA BIOFIATURE CESTIRE6 <br /> THI FDLLOMNO: 'I CIRFIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED.1 SHALL EMPLOY RgNSDN6 SUBJECT 70 WORIGIAN'S CaMRNN1ATON LAWS OF <br /> CAlRORN THE ANFL;CML7 MINTY C 24 NOURB IM ADYAICE FOR ALL REOUSKED PRTIOIN Ai <br /> I,iS-I ASBi4 , CRM 1X1AWIq AT LOWER AREA PROVIDED. <br /> K TNd. <br /> JL b.t+ <br /> PLOT PLAIT 13*+v.N ft"M.Mf •te_. --``,, <br /> I.NAMES OF STREETS OR ROADS NEAREST TO GR I/O TH <br /> SDUNOE PROIFiOY, ti LOCATION OF HOUSE GEYYAGE bloPom SYSTEM OR P11DpDBED�7" I <br /> l-OUTLME Of THE PROPERTY,GIVINS DIMENSIONS AND NOKFH DIRECTION. Ex'ANSIDN OF MEWAGE DISPOMAL SYSTEMS. <br /> 7.DRMENBIONED OUFUNEM AND LOCATION OF ALL fX"MNG ANO rporosEO S.LOCATION OF WEU-M WRINN RAdVe OF ONE HUNDRED FIFTY Ff.� <br /> STMWTUREI,LNCLUDRM COVERED AREAD GUCH AS PATIOB,OWVEWAYB,AND WALKS. ON THE PROPERTY OR ADJOINING FI OPERTY. <br /> 3 <br /> I <br /> VAYFAEN-r . . <br /> .: . . .... ..:. � � = .. 1= 8. 1 <br /> 139 . ..`. <br /> SAN <br /> : . .:.....: .:....... . �Hl IE'SOPJ <br /> ..,. - HEALTHSF ._ <br /> ENV:IRNMEN fAL HEALT <br /> OEP►RTMEIT UME ONLY <br /> Amftm%.A...p W BT- <br /> G,pu MrpxTld.or Om F1np I,�p+ePwl SY <br /> OM. <br /> D.I4-6m Mop.el6--By Dn. <br /> C.m1rtrrt.: ��z6`�L M M k !L 1 <br /> ACOoU11TiNG ONLY: AID,R FACA <br /> Ill CODIB Fire AMOUNT IU4uTTW IEC hlAen IIfCEIYEO MY DATE ipI;MTlMOIVIC!REGUEBT NUMBER INV^DICE <br /> F ✓ �pI <br /> &VD 5518' � I <br />