SU0008721 - Laserfiche WebLink

Home Browse Search

R PLI ATION FOR WELUPUMP PERMIT 9017 N.JOAQU N COUNTY PUBLIC HEALTH SERYICEBO ENVIRONMEMIAL WEALTH DIVISION B Y � 304 EAST WSWR AVENUE,mcKTON GA 9 of w 0 0 y 7 ,<l (2091 4BB-3420 11111012-AUUNDABLE PERMrr EVIRES I YEA FROM p TE Ssu leamplatt APPUCA7ION IS HERE BY MADE TO THE BAN JoAauW COUNTY FOR A PERMIT TO CONST: TTANUIOR INSfIALL 71¢ _ JOAOLRN COUNTY DEVELOPMENT TRIS,CHAPTER B-T 715.8 AND THE 6YANDARDB OF TAN JOAOUIN COUNTY g1BE1C HE1U.T�H�epgylCE!ENYI hu1VMEMAL HE/1).7H APPLICATION IS MADE IDMBtpNE WffH SAM iro JOSADDI¢SSMAPN/ 1+ iiiCITY /� PARCELS UAPN# . OINNER'I NAME r ` --�� ADORERS C. PHONE F�2PZ6 CONTRACTOR !-L Dd r 0. i c�'!M S ._ADORERa O •' LION PHONE F_231-X_7 p BUS CONTRACTOR ADDFIERR LION PHONE •TYPE OF WELL/PUMP: 19-ERlACEMEH[WELL ❑MONRonm WELL• ❑O 'y1-, ❑INSTALLATION 13 WELL SYSTEM REPAIR 0 CROSSCONNECT REPAIR ❑VAPOR EXTRACTION WELL# RYPEG---N-, �N#w❑R.F PUMP) a� H.P. J= DEPTHP MPSET�FT•❑.Olrt#SERVICE ❑ WE13FIRSTOIL FIRST WATER LEVEL !� I GEOPHYSICAL LL# BSO 1a RHG DESTRUCTION• T f o-Je L,, 17 g•- IITENDBD YP IIF CON* 1!C MN amc ❑INDUSTRIAL ❑OPEN BOTTOM DIA.OF WL7-L EXCAVATION I1'DOM ffrm CN/61LE DiA.OF CONDUCTOR CARING vATE p GRAVEL PA ^� �+ TYPE OF CASINGISTL:EiRVC LRA,OF WELLCASINO 1` ❑PVBLx%IMUNICIPAL D DRNEN #PTH OF GROUT REAL 1 ❑IRROOATION/AO ❑OTHER SPECIFICATION A GROUT SEAL INSTALLED eY GROWOF-ANDNAME C]MONIYOMNe GROUT SEAL PUMPEi C]W ❑V. Np�� E CONCRETE PEDESTAL BY DRSLE1x g AFIRlp7L Doi �_. ._- LOM"CHESTER BO%NSTDVE RPE PROPOSED CoNB711UOTIommpgtLENO R EriIOD:�MUD ROTARY_-_. AIR RDTMY AGOEq S CABLE_ �OTHER I HFgEBY CFIrt1FY THAT I HAYS PREPARED TH1R AFPLK•ATION AND THAT THE WORT WILL SE DONE 7N ACCORD AP=f GAN REOULATIONB OF THE BAN JOAQUIN COUNTY,HOME OWNER CA L1CCNgED AGENT'S WONATUKE CERTIFIES THE FOLLOY iii ERTIFYINTHAT III T NTYN �AtE IAVYB.ANp RULfe AND TMS PEM11T NS 168UEO.1 SHALL NOi EMPLOY PERSONS RUBJECTTO WORKMAN'S COMPL'NSATON LAWS OF CAUPOPNIA.'CDNTMCTOR'e AT I1G OR ANCE OF THE WORK FOR YRSCH THE POLLOWIMq; 'I CERTIFY THAT IN 711E FERPORLN6UCEAF THE WOIFK FOR Vi THIS PFRMR ISaBSUED•1 SMALL LGIRGY PEABONFSUBJECt iU6CpNTFµCTBYG MONATURE GSRIFTES CALIFORNIA.' 711 CART F~CALL 24 MoURS N,AOVAHOE FOR ALL REOWIED(NSPB6TIONS AT 1211B14W442S,COMPLETE DRAWING AT LOYVER AREA Y VIDEO. AT1oN LAWS of PROVIDED. i ekr+a x rk1. DMF �— LO— I PLOT PLAN(Dr—I.S.M.I ea.r. •, I.NAMES of ROADS NEAREST TO OR BOUINO1No THE PROPERTY. z. OUTLINE OF THE PEFOY,GIVNIO DIMENSIONS AND NORTH DIRECTION. 4.LOCA71oN OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED �.DIMtM=NED OUTLINES AND LOCATION OF ALL FX'BTMO_PROPOSED FXVANSION OF SEWAGE DI61iiii SY6tEMs- RTRUCTUREB,INCLUDING COVERED AREAS SUCH AS PATIOR CRVEWAYR,AND WALKS. S-LOCATION OF WELLS WLT`F"µ9R!6 OF ONE IRWOWD FIFTY FT. ON THE PROPERTY OR ADJOINING PROPERTY. �C ro.....,. 1 dkrd Q�rt�r .wn y .. ..:.....i ... .... : .. WIIF a 9TH Mol ! t. . Nr4! 6 ...t ce . � S_ . .. ... . #�A NT ....,. . F Eli FEE J. 5 AhAQ �I' c3L3N 9 BLI"MEAL H SERVICES 1 DEPARIMSIT USE oNLY ApvV—I.n A. Wt.y BY i Arr Gann kiii hn 8r D.t* ph ti.. Srymtl.R BY + i GMhvHl.n Imp..,I.n By DaiT2 1 C.mmm[r. I DNS I ACCOUNTING ONLY: ACDF FAC# PE COOM I'M INFO AMOUNT 111AUTTFD NEC NCASH I RECMVEo BY BATE 1SERNCE REGUpT NUMB IRYONCE so p s 36 `� b