Laserfiche WebLink
T 51'6PLi�ATiON FOR WELLIPUIIIIP PERMIT r I <br /> I <br /> ` IR dOADU N COUNTY PUBLIC HEALTH SERVICES O'{'%S <br /> ENVIRONMENTAL HEALTH DIYLSiON00417 , <br /> �� <br /> p C �.304 EAST WEBER AVENUE,STOCMN,CA Mol- ee <br /> (2091468-3420 <br /> WWREFUNDABLE PEAUFT EXPIRIEf F Y&I FROM 9A SSIi B <br /> (CBmp6tB b Tr1ptkltel <br /> AP4L.ICA110N W HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR tNETALL THE WORK DESCRIBED.THIS APPLICATION M MAGE IN COMPLIANCE WITH SA <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAFTER 8-1115.3 AND THE STANDARDS OF SAN JOAOUIH COUNTY PPuunuc HEALTH 6E1MCE8,ENVIRONMEMAL HEALTH DMBgN• <br /> ?e ms JOB ADURESB/OR APNO CRY_ .LTJ L''� <br /> PANICLE 812E/MRf/ /� f1 <br /> ONMER'S NAME Gi✓ ADDRESS S A^ e. , PHONE/9 G E3"' <br /> CON RACroRM p a rwL�,r<`C -tz, st K hl"S ADDRESS ! U WjrQAC ues FHONES 9-71-Z-7) <br /> SUS CONTRACTOR ADDRESS IUC/ <br /> PHONE/ <br /> TYPppp 1VELLIPUMP. �l KEPLACEMENT%AMU ❑MONITORING WELL/ ❑OTHER <br /> I <br /> ❑INSTALLATION ❑WELL SYSTEM REPAIR ❑CROSSCONNECT REPAIR {�VAPOR EXTRACTION qh'!L P J <br /> • !�lfd 1 JKN—❑P.,* H.P..-:r�. DEPTH PUMP BET 1 IJ FT. FIRST WATER___RL_ L <br /> RYPE OF PUMFI <br /> 0OUT-0P-SERVICE13OEOFAYWCALVVELL0 13 MOIL SOW NO S <br /> IG,DEITIIVCTgN• r 1 o p,'11, _/ +�J <br /> NDEO [ TYPE OF WELL CONSTRUCTION SPEcIHC TION <br /> U INDUSTRIAL ❑OPEN BOTTOM INA.OF WELL,EXCAVATION /JI�� VIA,of CO/IDUCTOR CASINO <br /> t W DOMESTICIPW VATE �ORAVEL PAcKtrAzE TYPE OF CAWN01STEERJA�C P)1!r• DIA.OF WELL CASINO h D <br /> ❑PUBIJCIMUISCIPAL 13 DRIVEN DEPTH OF ORDUT �! STZCIFICATWN O p <br /> 0 ING <br /> MOGATIONIAG ❑OTHER GROUT SEK INSTALLED BY 14 -C 11 i,C� GROUT BRAND NAME r . <br /> l7 MONITORING GROUT SEAL PUMPED:Pl Y_ 0116 CONCRETE PEDESTAL BY DFAUN:0 YM;`N6 S <br /> - APPROX.OEFYN_ ��I LOCKING CHESTER BOXNSTOVE RIPE S <br /> • PROPOSED CONSTRUCTIONMAILUNO MSYNOD;'-MUDROTARY�-__ AIR RDTAIIY A11DFx CARIE OTHFA <br /> I HEREBY CERTIFY THAT R HAVE PRIEPARED THIS APPLICATIOWAND THAT THE WONL VRLL BE DONE M ACCORDANCE WITH BAN JGAOVW COUNT'011VINANCE/.STATE LAWS,AND RULES ANI <br /> REGULATIONS OP THE SAN JDAGUrM COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE POU(VING:9 CERTIFY THAT IN THE PERFORMANCE OFTHE WORK FOR WHILT <br /> THIS PEIBWT IS ISSUED.I SHALL NOT EMPLOY PERSONS SUBJECT TO WOIWINAN S COMPENSATION LAWS OFCAUFORNIA•CONTRACTOR•B HININO OR SUSCONtRAGnHG SIGNATURE CE"IFIEI <br /> THE FOLLOWING: •1 CERTIFY TIIAT IN THE PEP"RMANGEOP THE WORD PON VA4CNTHIS P MIMI-I-ISJSSVED.-I-SHALL EMPLOY FEFW Ni SUBJECT TO•WORMAWS Com PEIISATIO14LAWS O <br /> CALIFORNIA.- ANT MUST CALL 24 HOAR&IN ADVANCE FOR ALL RSOMRED INSFEOTIONI AT M"I ssBouf.COMMET19 DRAWING AT LIMEN ARIA FRONDED. <br /> SI/mn X J TRU. <br /> PLOT PLAN alk—l6"lie'G"W <br /> 1.NAME.OF ADS NEAREST TO OR SOU <br /> N01N0 THE PROPERTY, i.LOCATION OF HOUSE WWAOE DISPOSAL SYSTEM ON PROPOSED <br /> I.OUTLINE OF WE PERrY.QIV MG DIMENSIONS AND NOHIN DIECTION. EXPANSION OP SEWAGE DISPOSAL SYSTEMS. <br /> J.DIMENSIONED OUTLINFA AND LOCATION OF ALL EXISTING AND PROPOSED B.LOCATION OF WELLS V/rrHW FAD"OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,ATS)WALK@, ON THE PROPERTY OR ADJOINDIO PROPERTY, ' <br /> :: res <br /> , ... <br /> ... .. ...a..�Jr..... .... <br /> W,t <br /> .. 1/an.e'yrM�. <br /> F,r7 ,, <br /> goal <br /> :,. <br /> 0 <br /> :.� 1j�art <br /> .. 9T <br /> 5 <br /> " !. <br /> d 90'd <br /> .a _o <br /> ,_ .. <br /> �5 r <br /> _ '..:.: :.:. . . .+�.. E fl 1997 <br /> 5 . <br /> .. <br /> DEPURTMTJrr uumnY <br /> L� APPIy,1I6n Axepetl M Dse6 rR 0 <br /> Nw " <br /> Dann ImPeLNl6n SY Ost67� P Lw..tlPn BY Dat6 Y/z <br /> p.rl,ueelen Irrp6oekn HY f L <br /> Cann.w: <br /> ACODUNTINO ONLY: HDI FACS <br /> PE CODES FEE INPO AMOUNT RD/ITTTD HEC ICASH I puled D BY GATg PLFwSTIBMRVICE IIEGUEST NLgRpI INVOICE <br /> SO .S�(, <br />