Laserfiche WebLink
,� oesy6 z <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOL IUNTY PUBLIC HEALTH SERVICES , <br /> r ENVININMENTAL HEALTH DIVISION C-Ajb <br /> P D BOX 388,445 N.SAN JOAUUIN ST., STOCKTON,CA 962¢ljl <br /> 12D9)468-342096 <br /> Fr�)CF �1N <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE IS UED�UG28 H <br /> r ICBNplINS in TTVNfitu) (� <br /> PPRICATRGN IS HERE BY MADE TO THE GAN JOAQUIN COUNFV FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE NSR(DFMCGS ED.THIN APPIIGATION 18 MADE M COW DANCE WITH SNJ <br /> .MAGUIN COUNTY DEVEtDPMEAT TITU,CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUB/J"C�HELLTN PVICES,EN ARCHMENTAL HEALTH OM610N. <br /> JB AOOPE68MP KNI CITY--N>�""�i PARCEL WOUN'N! <br /> YFfNNEP'S NAMf ADOIIESi 1� r1C �f110W6�27-.SLl7 <br /> CONTRACTOR - ADDRESS'�B7QPNRwl qlA—.C,3��o.31 PIMNEIj?7'7,5:ffl <br /> yJB coMMCTOn ADDRESS UG, RIOHE♦ <br /> TYH OF witLRJMP ❑NIIW WEu ❑mmIMEHT wFLL ❑MOWO.N.wELL, ❑OTHER <br /> ❑WGTAUATM& ❑WELL SYSTEM... ❑C...ONNECT PEPAIfl L VAMP EMPACTION WELL I J <br /> ❑Nw O1 , Xp. DEPTH RUMP SET ff. FIRST WATER UE O <br /> YPE OF RIMR <br /> ❑�OVT�OF6ERVICE WEl1 (L� �❑G�EORrv61CAE WEll! ��p ❑ 601E W{N�NO � � (� B <br /> K10EnRUCTIOIY� I'N`��I de-41( ?1.QL'Y� ]IIVN'�'T`� Lel/� fAJ'lJ1Y` h6.21�A '�/-YT.A-jlXi'rAA2L']!L <br /> y ( 1 FI I5PQ.. <br /> "TENQED USE TYPEOPWELL CONSTRUCTION SPECIFICATIONS <br /> I INDUSTNAL .JxOPEN BOTTOM DIA.OF VhLL EXCAVATpN DIA.OF CONDUCTOR CASING O^ <br /> ISI DOMESTIC.VATE 13 GRAM PACXWT TYPE OF CASINGISfEFLNVC DIA.OF CASING O� <br /> ❑PU.I .VNIMPAL ❑13. DF OF GROW SEAL 6FECIFMATON R <br /> 1:1IRNGATIOH/A4 0OTHER GROUT SEAL INSTALLED BY GRWT BRAND NAME E.{ <br /> J MGNmD. GRODT BELL RINGED:O V- O N. CONC0. SIC <br /> PRMX.DEPTH /215' <br /> ...C...BOXBTOVE FN£ S�� <br /> rM0 <br /> POSED COXeTPUCT10NlORWNO METHOD: MUD RDTMV AIP roTARV AUGER CABIF OTHER f <br /> 4EREBY CERTIFY THAT I HAVE PREPARED THIS PR EC NANO T EW THE WON(WILL BE DONE IN ACCORDANCE WRH BAN JOAQUIN ERTFY THAT <br /> IN HEMNANCE6,STATE.Am.AND RULER ANO <br /> HIS PERMIT <br /> OF DED,IN JOADOT COVNTY. HOMPERSONS <br /> SUBJE T MEWED AGENT'S COMPENATURE SATION <br /> CERTIFIES THE FOLL IA.NC:'I CERTIfY S HI IN THE PEPFONAANCE OFTNE VARI FOR WHICH <br /> H16 PFf1LIR I6186UF➢,16XALL NOT FM0.0V PERSONS 6USJECT TO WOREMAN'i COMPFN6ATIOH IAW6 OF CFIIFOIINIA'COMMCTOP'6 HINNG OP 6UKONTAARING 6MNATlIiE GFRTIfIFB <br /> "B"E <br /> WLLOWINO; CERTI THAT IW NE FFAEORMANCE OF TXE WOR(FOR WNMX TRIS PERMrt I6166UEO, 6XAlE.EMRDV PERSONS 6VBJECT TO W OM'MAH'E COMIFHSATMN IAWb OF <br /> CAUFONBA' T' PUC VfT {HOW INADVM'CE f00.ALL REOMPFD IHi T10MS /I�EO�BI�MB.'MEf.COMRETE OMWIN4 AT LOWED APER R(V�JWOED.�T ���//`�pN{. <br /> BbN.1 <br /> FLOT PUNIOtwv 108uMI RaW <br /> . NAMES OF 6TREETB OP MID6 NEPAFST TO Ofl BODNDINO TXE TOFEMY. 0. LOCATION Of IpDBE SEWAGE DISFOSAL SYSTEM Ofl P11GPoSfD <br /> BT. ODTUNE OF TXEPROPERTY.4IWHG MMEN6MN6 ANO NORTH gflECTMN. FXPANNON OF 6EWAOE M6N6AL BY8IFM8. <br /> ]. DIMENNONFD OIRUNEB AND IGCATION OF ALL FX I6TIXG ANp iM106U) 6.IOCATMN DF WELLS WTTNIN MOIV6 OF ONE NUNODEO RFTY FT. <br /> 6TRUCTUPE6,INCLUDING COVERED gU1FAe SUCH A6 PATIOS,DRVEWAYB.PND WAII(6. ON THE RWfFIT'OP AOJOINIH4 RWFFRTY. <br /> 1,16 t g 1996 <br /> o � <br /> R� I <br /> 71 A)<") <br /> ) i Iao esC /� <br /> /93�-g A/ <br /> �4 cktv,,e <br /> II �I <br /> �t DEPARTMENT USE ONLY <br /> APPIIuibn AaeglM <br /> mnN lmwtlm BY wn PumP Impe[Gun BY wi. <br /> A.lry EW By— <br /> PLATE <br /> 11, Page 10 of 16— <br /> ACCOUNTING ONLY: AID, fAc, <br /> DECODES MEIRM IMOUHTRFTOTTFD ABH RFGDVFD BY DATE PEIIAYTIMPACE REQUEST NUMBER INVOICE <br /> p 7373 ,� R 03193 a-- <br />