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LJ DESTRUCTION: <br /> INTENDED USE T lF WELL ^— <br /> CONbTRUCTION SPE< .1 ION6 <br /> ❑ INDUSTRIAL G OPEN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CAI <br /> ❑ OOMESTIC/PRIVATE ❑GRAVEL PACK/SIZE TYPE OF CASING/STEELlPVC DIA.OF WELL CASING_ <br /> ❑ PUBLIC/MUNICIPAL IJ DRIVEN DEPTH OF GROUT SEAL SPECIFICATION <br /> ❑ IRRIGATION/AG ❑OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME_ <br /> ❑ MONITORING GROUT SEAL PUMPED: ❑Y. [IN. CONCRETE PEDESTAL BY <br /> APPROX.DEPTH LOCKING CHESTER BOX/STOVE PIPE <br /> PROPOSED CONSTRL/CTIONI'DISLLINU METHOD: MUD ROTARY AIR ROTARY AVGER CABLE OTHER- <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORD(WILL BE DONE IN ACCORDANCE WITH BAN JOAOVIN COUNTY ORDINANCI <br /> REGULATIONS OF THE SAN JOAOUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT IN THE PER AI <br /> THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR SUB-CO <br /> THE FOLLOWING: -1 CERTIFY THAT IN THE PERFORMANCE.OF THE WOR(.FOR WHICH THIS PERMIT 18 ISSUED, I$HALL EMPLOY PERSONS SUBJECT TO WORK <br /> CALIFORNIA.' THE APPILICANT MUST CALL 244—HOURS IN ADVANCE FOR ALL REOUIRED 44 <br /> INSPECTIONS AT 120)4662]. COMPLETE DRAWING AT LOWER AR <br /> slaved x 7L4 lriJ/iL� ' Tine lu-P <br /> Du <br /> PLOT PUN (D,.to S,W.)Sul. to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISK <br /> 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL 8l <br /> 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS <br /> STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PFK <br /> 4vw tl <br /> P <br /> a„ <br /> AID <br /> .jam) AW k <br /> �✓' 1` SAN G" <br /> PUBLIC'H <br /> EWRONMEN <br /> DEPMTMENT USE ONLY (� <br /> Application Accepted BY pete�7 1 <br /> Grow Ins'. .fon By a Pump Inspection By <br /> Dmttuctlon Inep.ctlon By <br /> DNe <br /> p n <br /> Comment.: '1 C'O:L'c NE �-- - v �57/f ffnn><- j<'% >- //d PHC' � _36^`� <br /> F.V C�.I�SC�� lYV C p q/ "S (�j Iro�""f 'MfTo Iu I SITE—R7 t <br /> ACCOUNTING ONLY: AIDI FAC4 ClJS/UvyN SL <br /> PE CODED FEE INFO AMOUNT REMITTEDHECK CASH RECEIVED BY DATE PE —.".ERVICE REQUEST NUMBER <br /> LPA 41-71% <br />