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ENVIRONMENTAL HEALTH DIVISION <br /> ' P 0 BOX 3811, 446 N. SAF!JOAQUIN ST., STOCKTON.CA"— ]1.388 <br /> 88. <br /> r <br /> 00S) 4W3420 <br /> ` ff <br /> IIyl iypaAB] VIk4ff E R11JJ 1Mill ROK DATE ISSUED <br /> Icomplete M TripBsetel <br /> AppticstlDn is here by evvk to the 5nn Joaquin Cwnty for it permit to construct and/or fnstali the work described. This application Is <br /> made In coNplionce with sen Jaafluin County Develorswnt Title, Chapter 9.11153 and the Standards of San Joaquin County Public Health - <br /> Services, Enylroneientel Health Dlvf+lon. <br /> Job Addrtss/or APwlt­k+� City 7Parcel Sfre/APNt /l1 At-A!;:2:_ <br /> Owner's NA+iie� y AddfeR+< /• RF✓��lF_-V Phone �if U/lrf9 .. <br /> �CContreetor _ � �l� � vhane s���� � <br /> r <br /> Sub Contractor_ _ AMre++ Lica Phone R <br /> TIP£ DF NEIL/DUMP: )C NEW WELL (1 atPLACfMFNT WELL (I WAITORFNG WELL N ti OTHER - <br /> I) OESTRUCTION (I ntlf.uF.SERV:C1. WF;II (1 CEOPwYSICAL WELL 0 U SOIL BORING <br /> [( INSTAWLATION [1 Wrll SYSTEM REPAIR 11 CROSSCONNECT REPAIR (1 VAPOR.EXTRACTION WELL I W <br /> i {1 New [I Nepali, N.P. OEPTw PUMP SET FT, FIRST WATER LEVEL <br /> I. (TYPE OF PU1WP) - a0 <br /> IMT�1p�D�IBE ILP1.4` AIL6 SORITIF(IGTIDI(SPE F �ITiDNt <br /> 5 EI INDUSTRIAL It OPEN COTTON Ofa, OF WELL ENCAVATIrW !2./Aur&. DIA. OF CONDUCTOR CASING 1`r` [rrj x <br /> *tDKST(C/PRtVAIt gGRAVEL PACX/SIZtQ)( 2. TYPE OF CASING/STEEL/PVC /'TV(w, DIA, Of WELL CASING <br /> (I PUBLIC/.'47NlCEPAL !1 DRIVEN DEPTH OF GROUT SEALIQ�T SPECFrICATION J�"iF� (d O. '� $ <br /> (1 IRRlGA11Cis/AG (1 OTNER GROtIr PEAL INSTALLED BY F&APW4 GROUY BRAND NAME =flxj <br /> ! It MONITORING GRWT SEAL FWED. -e,-Yee EI No CONCRETE PEDESTAL BY DRILLER: (I yes (3 No <br /> APPROX.DEPTN,�1k-1 LOCKING CRESTER Sox/STOVE P:-JE <br /> PBOP011E0 CONS 1GUCTEONiDBill INO RiETNODI MlA ROTARY AIR ROTARY� AUGER____CABLE OTHER— <br /> and Y ,i '� <br /> [ hereby certify that 1 have prepwr to A app; ca�ta+ that the work Will tee done In accordance with San Joaquin county Ordinance, ; <br /> ` t7 Irate Laws, and Rules sen <br /> Lind Regulations eI the Lan Joaquin Canty. Now owner or licensed spent+s sigruture certifies the following: NI x <br /> certify that in the perforeTence af,'the rorW for Which this pare It In issued, [ ahat l not employ personsatbjeet to NORKMAN'S COltoENiATION j <br /> laws of California.^ Contractor's hiring or sub•tontracting signature certifies the fottowing: N 1 certify that in the performance i <br /> 4yw�y vtrP of the Turk for which thin permit Is Isnixd, i shat) aagioy persona abject to WORKMAN'S COMPENSATION laws of California." TNEAPH1CAIiT <br /> e i MUST I 24 M AS A ARCS DR Alt 11111041111110IRIPECTfORS AT 920014411-3421. Corptere drawing at r area provided. <br /> 1'. — <br /> ;4 Signed X1` Title Dat <br /> r <br /> y ipsrL r PLOT PLAN (Orate to Scate) Scale N tD <br /> Hames of streets or roads nearest to or bounding the property. R. Location of house sewage disposal syntmr or.,- <br /> <S 2. outline of the pr+.+perty, giving dfwenslDns end North direction. proposed expansion of sewage disposal sysrema.• <br /> 3. Diatrneiortud a+tl(nes aM location of ell eNistEng and proposed <br /> S. location of wells within radius of 150 ft. on <br /> structures, Including covered &1`10611 such as parl69, driveways. She property or adjoining property. 1 <br /> and walks. <br /> bF` E*+x <br /> Pt ISLI NI Ci t;L'i <br /> 'ft ` <br /> 5t r .�3 <br /> My� IT C:. �' ti♦. <br /> r 'S` t1`• k -�, W. <br /> J. <br /> DEPARTMENT USE ONLY ^T`' <br /> dd <br /> c irk =etc 1.; Appl cation Accepted Ry Date Area .� .� <br /> 11 y1,1'a i -� 44 <br /> ttilut Pee,Ion Sy _ Date ��P Inspection By Date y <br /> -e - -; <br /> Drs tion InsrttiOn BY -- — Date CommeT+ts: e ; <br /> x 1 A ACCOUNTING OlIY: AFDR FACT <br /> .,•ter .T �� - <br /> 5 PE COOES FEE MFG AILOUNI RIN(TTED E CABN RECEIVED BT DATE PFRY(TIB�RY[CE REgUEBT RUiI R MVGICE <br /> (7 i? A <br /> i <br /> -;�, ,���-. ;� T+.wi..,::,.y a e.L•at=aw;=}F.�e:�.�'� .;,s:.tM,-.1`,Z;. yT ,s,. .r ,. .. ..,_.. . ... . .. _ .... ..' � <br />