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........... -, — -, nn n ..HI Y FOO A PERMIT TO CONSTRUCT ANOMR INSTALL THE WORK DESCRIBED.THIS APP CANON It MADE W COMT8IANCE WHIZ BAN IOAT`UM r.,_NTY DDEEVELELOO M/ELNTT TATTLE.CHA�PITIN 99--I 115.9 AND THE STANDARDS OF SAN JOAOUIN COUNTYPUBLIC HEALTH eERWIS.FNNMNMFMAL IRAUN dNtgN, JOB .O gAPNF/'/r)F/IC(�!Y /C/` CITY A /H -"-Of PARCEL SIMAM1_3 ACDFrS. OWNi. NAME /NLI'A I 1/il//>--y 77L/r ADDRESS �:2-2Qog 7�,41,t// ,2fJ/.P/1 PjAoE p,�i49V_t jgjP��TJ.i?T�7- NT CORACTOR CALF /70/ L. T/C ADpRE66 S. 7LY/�O[I�II[/Q }�LF RRONE FC BUB CONTRACTORRACTOR ADDRESS l - - LICI PHONE I TYPE OF WEWPUMP, LCL NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL/ ❑ OTHER ❑ INSTALLATION ❑WELL SYSTEM REPAIR ❑ CR196{ONNECT REPAIR ❑ VAPOR EXTRACTION WELL I J ❑NW,❑RRR.IT N.P. 11 DEPTH"IMP SE FT. FIRST WATER LEVEL O Rl'PE OF PUMR ❑ OUT-OF-SERVICE WELL ❑ OEOPHYSICAL WELL I ❑ SOIL SORING 8 ❑OEBTRIIC1bN: KWfTLMDm UfE TYPE OF WELL CONSTRUCTION SPECIFICATIONS Jeb NBK18TNAL ❑OPENSOT-TOM GO,OF WELL EXCAVATION 12 LAL66L OIA.OFCONDUCTORCASINGG ❑ DOMESTMIPRVAIE �HUQRAVEL PACIKISIEE JJX/ TYPE OF CASINGMTEELIPVC (V r IRA,OF WELL CASING L /�[ O ❑ PUSIKRAUMCNAL ❑OSIVEN DEPTH OF GROUT SEALILVCT SPECEICATION 5r9L.7Lo R ❑ IISSOATMNIAG ❑OTHM GROUT SEAL INSTALLEDqSIYCHL GROUT BRAND NAME C- E 13MOdTORNU GROUT S(AL PUMPED. UYs [IN. CONCRETE PEDESTAL BY URILLFR:❑Yr;Ej� s APIDx.oflfN I�r LOCKING CHESTER SOX/SI OVF RPE s PROMISED CONSTIUCTIONIDNWMO METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER O 1 HEREBY CFRTFY THAT 1 HAVE PRPAgf.D THIS A ATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAGUIN COUNTY OROINANCEe,STATE LAWS.AND AllLt ANIS •1 CERTIFY THAT W THE PERFOR "ODUg TNO OF THE SAN!GAOLER COUNIY. NOME OWNER OR LMEN6FD AGENT'S SIGNATURESIGNATURECFRTIFREB THE FOLLOWING: MANCE OF THE WORK FOR WHICH THIS PERSIST IB ISSUED,I SMALL HOT EMPLOY PERSONS SUBJECT TO WORIWAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S RISING OR SUBLONTRACTM SIGNATURE CERTEE6 THE Y THAT THE Of THE WOM FDA H THIS TO WoRISSAN-S COMPENSATION LAWS OF CMIMM, �:1�1 CE :I T MUST LL 211OLNAIN ADVANCE FOR ALL REQUIRED INSPEMIT 19 NG ATSUOSI 468JFEl MCOMRETF DRAWING ATT TLOWER AR AAPLO IpED` � IF fcuslJ TRIe, 11i23 FLAT PIAN IDO-I.S .I SON. R,J / Q 1. NABRAG S OF BISECTS OR ROS NEAREM TO OR MUM,,,,THE PRIPERTY. 4. LOCATION OF HOUSE SEWAGE DISMSAL SYSTEM OR PROIg6ED ^ E. CU'UNE OF THE PROPERTY,UMNA dMEN8ON0 ANO NORTH DMFCTgN. EXPANSION OF SEWAGE dSPOS&SYSTEM$. O. d EASONED OIITLMFB AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUMORED FIFTY IT. STRUCTURES,MLUDING COVERED AREAS SUCH AS PATIOS,MVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. MADR(/l+A kD. 4QJFi l G suoP syr,sN N w---E s DEPARTMENT USE ONLY ApplbFllpl AOOTI01 BY DHe L� 1 ' �y..�� GORR lRN~I4R BY 0.1. BY O.le De.VwH.R Ir.pe.11m$r D.le ACCOUBTDO DAILY: ARM FACT Qi - "CODES FFE INFO AMOUNT RR.IITTED C C MASH RECOVEDBY OATH 19MITRFRWCE REOUfST NIFNt[A INVOME