Laserfiche WebLink
P 0 80X 389,445 N.SAN JOA4Ul+v ST, 1(TON,CA 96201•399 <br /> R (209)469.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> icomplate is Triplicate) <br /> Application is here by made to the San Joaquin County for a permit to construct and/or install the work described. This application is <br /> made in compliance with San Joaquin County Development Title, Chapter 4-1115.3 and the Standards of San Joaquin County Public Health <br /> Services, Environmental Health <br /> Divisiion. ���� <br /> Job Address/or APNq "`1 1 �'+ �' rt4"--L—t City ii %' Parcel Size/APNY - <br /> F i <br /> Owner's dame r �r. .'r ddress`�f�1-,�C�L j �-' Phona itI <br /> �r R. Address t-� F� cR e l',r T-L i c#w - '�` Phone it!"zl-!-Z -�27 <br /> Contractor r` - <br /> Sub Contractor Address Lic# Phone # <br /> TYPE OF WELL/PUMP: NEW WELL [] REPLACEMENT WELL [] MONITORING WELL N [] OTHER <br /> r] DESTRUCTION [I OUT-OF-SERVICE WELL [1 GEOPHYSICAL WELL # [] SOIL BORING <br /> 11 C] INSTALLATION (1 WELL SYSTEM REPAIR [I CROSSCONNECT REPAIR [I VAPOR EXTRACTION WELL # <br /> iDEPTH PUMP SET FT. FIRST WATER LEVEL <br /> New p Repair H.P. <br /> (TYPE OF PUMP) <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br /> [] INDUSTRIAL (] OPEN BOTTOM DIA. OF WELL EXCAVATION /,A _ DIA. OF CONDUCTOR CASING <br /> i <br /> [] DOMESTIC/PRIVATE .Y GRAVEL PACK/S1IEA TYPE OF CASING/STEEL/PVC P tI ,C DIA. OF WELL CASING <br /> " (1 PUBLIC/MUNICIPAL [] DRIVEN DEPTH OF GROUT SEAL I rl ._ SPECIFICATION T IC '-'(.+,-iti J <br /> - [1 IRRIGATION/AG [1 OTHER GROUT SEAL INSTALLED BY, If• (�) _ GROUT BRAND NAME_ C i :. _— <br /> GROUT SEAL PUMPED: XYes [t No CONCRETE PEDESTAL BY DRILLER: [I Yes QNo <br /> [] MONITORING <br /> APPROX.DEPTH�r .L0 jQ - LOCKING CHESTER BOX/STOVE PIPE <br /> PROPOSEB CON8TRUCTIONIORILLI1IG METHOD: MUD ROTARY AIR ROTARY—AUGER_CABLE_OTHER_ <br /> I hereby certify that t have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, <br /> Stats Lays, and Rules and Regulations of the San Joaquin County. Home owner or Licensed agent's signature certifies the following: "I <br /> certify that in the performance of the work for which this permit is issued, 1 shall not employ persons subject to WORKMAN'S COMPENSATION <br /> Laws of California." Contractor's hiring or sub-contracting signature certifies the following: " I certify that in the performance <br /> of the work for which this permit is issued, 1 shall employ persons subject to WORKMAN'S COMPENSATION Laws of.California." THE APPUCAMT <br /> MUST CALL 24 HOURS IM ADVANCE FOR All REQUIRED INSPECTIONS AT(20214811-3423. Complete drawing at lower area provided. <br /> Title <br /> Si9n <br /> - PLOT PLAN (Draw to Scale) Scale " to <br /> 1. Names of streets or roads nearest to or bounding the property. 4. Location of house sewage disposal system or <br /> 2. Outline of the property, giving dimensions and North direction. proposed expansion of sewage disposal systems. <br /> 3. Dimensioned outlines and Location of all existing and proposed 5. Location of w � l�gdius of 150 ft. on <br /> structures, including covered areas such as patios, driveways, the property lad d � p'rroperty, <br /> and walks. <br /> r - 00, out C, <br /> f B <br /> t V 71, <br /> tz <br /> 1'+i <br /> I L-A I I <br /> El <br /> k <br /> �T <br /> �) <br /> • �7 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date <br /> r Grout Inspection By "� Date � � Pump Inspection By f Date 7R/ <br /> f <br /> Destruction Inspection By pate Comments: <br /> 5 9 j <br /> 1 <br /> ( <br /> I <br />