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APPLICATION FOR WEWPUMP PERMIT SAN 1G1UIN COUNTY PUBLIC HEALTH SWF . ES a ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (209)468'3420 X0WREF0RDA9t FEp EXPIRES I YEAR FROM DATE ISSUED Mompi*L*In TtkkotW APPLICATION IS MR BY MADE TO THE CAN JOAGUIN COlMfY FOA A PE WIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESptIBEO•.T7pG APtJCA7ION tG MADE IN COMPLIANCE WITH S/ JOAQMN COt1NTY DEVFLOFMENT TRt,E/,/pilar m 9.1 1/1�6.3/)_AND THE STANDARDS OF GAN JOAOUIN COUNTY PLWX HMTH geq%WM MVMONMBrrAL HFJLLTN OM R JOB ADOW IOR MW 3 �l 4 �(Y //SIPS` CITY ® PARCEL SMAPNF Vim-•J�LF ? . OV""'*NAM T /' ADOf1£SSI�Vqt PHONE P T 1 ` ( coHrtucroR 11AI&Aj ( MORE. C/< ucsjftffj'MORE s j Pitt CONTRACTOR ADMIEGS tics RSpNE i TYPE OF We.L/1 t.4- 7"ttEW WCL ❑vwkAcomw waL ❑ Mo ORHOtNTT WELL/ ❑tmtER ` ❑RMALLAHIDN ❑ REPAIR EM ❑ C'N08SCONHECr REPAQl ElEX VAPOR TRACTION WELL s f 11Hevr❑Repelr x.aV CT DEPTH FVMP WrLo— . FI RGI WATER LEVEL ®O� RYPE OF PUMP) NI� ❑ ow-or-same a wm ❑owptreE1C44.WEtt r ❑ 901L W mm f F i ❑DESTRUCTION: �--j N7ENDED tiff TYPE OF WELL CONSTRUCTION BP£St ATTONB t� CI M+OUGTMAL ❑OPEN BOTTOM TAA.OF WELL EXCAVATION— OM.Or CONDUCTOR CXSmpf r ��[� ., DOItE*TICARIVATE ❑{+RAVEL aACfclar:E /V TYPE of cASINO/STN�/PVC 1'1 tf_I�. aA of WEU cAsnro ❑PVVIKA MUWAt. ❑DIwEH at""OF Grow PEAL '�"-7 SPE'COXAT10N � + ❑MOATIONIAO 110"m GROW DRAH[IHAM*. g* a Nfj't' 1 ! U t.1OMrOMN6 GROUT WAL"]WED.payee ❑Ne CONCRETE PEDEGTAL GY OMLLEt@JffYw ON. APPROX OTPTH LOCKING CHESTER DOXISTOVE PIPE PROPOSED COMSTRTK:TION/DRIWNO METHOD: uw ROTARY_ADH IIOTARY AXIM CAKE OTHER- -I HEREBY CERTIFY THAT 1 RAVE PREPAREO THIS APPMADON AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOM COUNTY ORWHANCES,STATE TAWS.AND MJLEG M FFF j REGIMTIt"OF TM BAN JOAOM COUNTY.HOME OWNER OR LICENSED AOM'G IROHATURE CERTIFTEG THE FOLLOWPtM'1 CERTIFY THAT DI THE PE/V'ORMANCE OF 711E wOIK FOR WHtt THD*PEWIT IB f**IIED.I*HALL NOT EMPLOY PERSONS GUSJECT 70 WOTWAAN'*COMPUMATION LAWS OF CAUFOMA•' CONTRACTOR'S WFPIG OR SUS-CONTRACTINO G{GHATUM CERTIFT THE FOLLOWING: '1 CERTIFY THAT IN INE PERFORMANCE OF THE WORK FOR WNCH THIS P9WtT M ISSUED.1*HALL HLHPLOY PERSONS SUBJECT TO WOMIOR/AWS COMP[NBATNIN LAWS i riCAfhOR1NA.: x ' KOT PIAN(brew to eeei.t Geele 'M 1.NAMES STREETS OR ROADS P/E/NtEST TO Oft BOUHONIO THE PROFIN". G. LOCATION OF HOUSE SEWAGE OIROGAL SYSTEM OR PROPOGID Ir 11{ 2.OUTIMI OF THE PROPERTY.GIVING DIMENSION*AND NORTH DIRECTION. EXPAU&M OF SEWAGE DISPOSAL SYSTEMS. F !. DOW4900WO OVTLATEG AND LOCATION OF ALL MOTINO AND PROPOSED S. LJ>CATION OF WELLS WITHIN RAOAIS OF ONE HUNDRED FO`Y FT. *TR(JCTVRE*,INCLUDWO COVERED AMEAS SUCH AS PATIOS.DRIVEWAYY.AND WA KB• ON THE PROPERTY OR ADJORIRIO MPERTY. ..................{........... ..... .......p.............y...... ......:.... _ : T I ..i f.. ...p.....i.. .p... ..y. .,.C.. .s. ...1.... ...p• ..... . ... �.. ..;.. ..'j..... .a.. ... ! ..t.. ..s.. f ..�•... ...$ . ... ....b.....' ...�.. ? ..q.....1 .. , i - c 7 v... ..>..........y.......... ... ...... ..3.... ....t.......�.....• ....i......s.............b.. .4. ...p......:....ir......:......y..... ......b._ ! �'''1 .q............... ...4o.. ...g.. • .: ... .. ... . F 1 ;.. ..6... i... }... F� }... 3.... • • : t , \a\ • : .... ; : 1 i i.. IS ..o • 1 : .. ..�.. .._;.. ..5..... .-p......... . ...j.. ..j............ ..y. ... : : ..p.. ...j... - ...p... ...o... i......�.. .. ...�.... .y .p......:......{..._ ..�. :.t... . . . . i ! . ...................... •r'e. ...:} lW' ............iy... .........y......:...... -....'......Y ... ......... .i.....:.............:......p......:......d... .. ..... .-4......:...+9 V. p............2......:.............:. . ..a. ......5.. ...�..............�... ......e......}......e......'y..._.a y.a ...o.. - - .i•. ...}.. (fLj-S•••4R......t .:��J' . i • ._ . ...:...,..r......:.....:......_.....�......:..... .............o.....:......a_ ...�.... ..g.....a... .i...--a._.,.. . i, a ^:y�.t.RTu?i�E�PJ:}+.* .3.