Laserfiche WebLink
APPLICATION FAR WELLIPUMP PEAMrr 00q'75'7 <br /> y,G•'`,:-':,.:'�;`:"� N,,IpAOU N COUNTY pA]BLIC HEALTH SERVICES 00q 7CIr <br /> ENVARANMENT-ii HEALTH DIVISION <br /> P 384 EAST WEBER AVENUE,STWKMNI cA Smtsm °O Y7 91 <br /> V. 42091468-3420 <br /> NOWNEFUNPAREV PERMIT EXPIRES 1 YEAR FRI SATE 113UEo <br /> [QDnFAn 1&Tr}}(aua) <br /> APFLCA?ION$3 HERE W MADE TO THE SAH JOAOURi COUNTY FORA PFIVAFT TO CONSTRUCT AROIOR INSTALL THE WOIK DEFCN6F0.THIS APPLICATION IS MADE P,COMPI.fANCE 1NRH 8A <br /> JOAOUM COUNTY CrA"PMEM TITLE,CHAPTER 9-T T 79.3 AND THE STANDARDS OF SAN JDACKM COUNTY PUBLIC HEALON BEIMCER ENVIRONMENTAL HEALTH OIHsm. <br /> JOB ADtftRRID11 ATNa c •-k <br /> rry PARCEL W2EfANJF <br /> OWNER'S NAME' ✓ ' ` ADDRESS C. PHONE F� •_• <br /> COhRRAtto ✓ A. ✓ - M S AODREci O <br /> SUSCONTRACTOR --�-�� <br /> ADDREse Dc� <br /> PHONE e <br /> 7�E.OF WEL1J1!U1,AP. �IIREyyyIIER REPLAcEMEM WELL ❑MONITORING WELL f D OTHER_ _ - <br /> ❑SNTALLATION ❑WELL SYSTEM REPAIR ❑CRO&s-coNRECTREPAIR O VAPOR M..CTION WELLR <br /> ' ON—QST M.P. Jt DERHPUMP SEr 1i'FT. • 7 <br /> RYP'E OF PULHI FONT WATER <br /> 1 'Q,OVTOM1SERVICE ❑GEOPHYSICAL WELL R Q SDR aORIIq d <br /> �DEdTiNNtTION: <br /> 'NI <br /> T WDB7 YFE O ELL <br /> toea TIO c c A an! <br /> r ❑OOUST1tlAL QOPEN SOTTOM <br /> WOOF WELL EXCAVATION_ Ian` �` DIA.OF CO'NDUCTORCA88q_�"�+� <br /> Il OMSA.WnCARNATE �OMV0.PAC NIZE TYPEOFCAVNOMTEELIPVcjfG Oµ,OF WV CASH P <br /> ❑PUSLICILILNNICIPAL Q bIEU2N DEPTH OF GROUT SEAL <br /> SPECIFICATION & <br /> ❑IRPoOATIOHIAO Q OTHER OROLIf PEAL INSTALLED FY <br /> �IppTT GROUT SRAND NAME E <br /> ©MONTTOPoNG i GROUT SEAL PUMPED;plYr 13 No <br /> CONCRLTF PWMI;rAL BY ORULLER:Q Y" IG:. d <br /> AFPoIOIL D&FIN (� LOCKING CHEKEII lOIfKOVB PIPE P'"'° <br /> PROPOSED CONSTIIIICTIONICAILUNG METHOD:MUD ROTA" AIR ROTAIIY AUGER CA��OTHER^ <br /> I HEgEBY CERTIFY THAT I HAVE PREPARED THIS HOME OF THE BAR JOA0MIlJCATIQN fl ORLAND THAT THE WORK WILL SE DONE IN ACCORDANCE WTI <br /> REOUN SMR JOAOUIN COUNTY ORDINANCES.f,KATE LAWS,—ANP RUM ANI <br /> TATroN! 1lIN COUNTY.HOME AGENT'S WGRATURE CWrRFIE!YM FOLLA6NRpi•R CERTIFY THAT IN THE PERFORMANCE OF THE V FOR WSSCI <br /> THIS PERMIT IS ISSUED,1 SHALL Not EMPLOY PERSONS BUSJECTTO WORXMAN's COMpOIeATlaN LAWS OSCAL"MaA.•COMIACTOR'BHPoIq OR sUBLOMRACTNG mOHATLIRE C 11D <br /> THF FOLLOWINO; •I CERTIFYTNAT IN THE PERwRMANCE.OF THE WOFK FOR WHICH.TRIs.IXRMR IIHALL EIAPLOY PERSON"BUWECT TO-WORKMAN'S COMININ neN LAWS a+ <br /> CAUFORNIA,- CANT MUST CALL 2a NOURe IN AbVANCI,FOR ALL REOUARD RISPRI AT RP814&S.M28,COMPLETE ORAWING AT LOWER AREA PROVIDED. <br /> Waw <br /> PLOT PLAN mrm to cbw4d <br /> 1,NAME&OF RIOADB HEAREDY TO OR SOUNt)OM THE PROpOITy, ^- <br /> !.OW U.NE PERTy,OIVI a.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR pROPOSEb <br /> NG ION OF ALL AND NORTH DIRECTION. EXPANSION OF SEWAGE OIOi m&YBTEMB, <br /> 3.dMENS1ONEb OUTISNF.e ANo LOCATION OF ALL EXIS►ING AND PROPO&Eb I <br /> sTRUCTVIgs,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS, !.LOCATION OF WELLS WRHRN RADIOS OF ONE HUNDRED pWry PT. <br /> ON THE PROPERTY OR ADJOINING VMVER". ' <br /> _ .�,._.., <br /> R .. <br /> i Q 4e' 0 .. <br /> e � <br /> .,......... <br /> ..a. < <br /> C - <br /> f ' <br /> n <br /> r I. <br /> ..... f„ ...f - AI <br /> T :........,. ;raArC,f +l �o .. <br /> :.. <br /> FE 001597 <br /> — f..._ EN4'i. <br /> t OEPARTMFNT UaE ONLY <br /> I APPBEHiv,A•o.Pted SY O.Da � /4r-�I'�' <br /> O.eul InRPwsm sr //��TT <br /> DICR—g ClP It q teen or 0 f <br /> I Ow—flan In•Pecft.BT Dal <br /> * 9 <br /> L Dote <br />{ Ca111IldHP: <br /> t ACCOUNTING ONLY: AIDA FACE <br /> s Pe CODE& FR INFO AMOUNT IIEMITTL•D IRC lCAeH I IIH••om SY DATE <br /> R7MITrlETMOE RELLLIES7 NUA4pl MYOICF <br /> Iftb�� 3 <br />