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TFI...� _..._.__ sle JOApVIN CO DEVELOPMENT TREE.CHAPTER , 1 APPLICATION I9 OEM BY MADE TO THE SAN JOAQUIN COUNTY FOR A PEJOAIT TO CONSTRUCT< IANDIORI INSTALL THE WOW DESCRIBED.TIIIB APPLICATION IB MAGE IN COMPl1ANCE WRlI9AN �NIY 81116.3 AM VT DA B OF VAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,M"PIONMENTAL HEALTH DIVISION. JOB MANESSi R APR/ Z 6 y 1? S�E L� /////y PARCEL 9RF/APFFI CONFgACTO /l.(J ff :/J CIrI—=ate 1 OWNER'S NAMF CONI ICALZ VIJ« ADOdap p �E I fN K O SS gE68 R' /� 1� -ADDRESS ,/J �� I,� : V W L� ra UHO CI3 73gS PNF t 3 MY�yJ = RUB CONTCTr OP r F ADDRESS /'E C LIC/ PHONE/ 11 TYNE OP WFLNEW WELL ❑ REPLACEMENT WELL ❑ MONROPIM WELL I ❑ OTHER I/V ,H A,STALUTION ❑ WALL SYSTEM REPAIR ❑ CROSS CONNECT REPAIR ❑ VAPOR EXTRACTION WELL/ SLU 11 New[jp R .1, A, / J RYPE OF PUMPI DEPTH RUMP BET PT. FIRST WATER LEVEL 1 J - D ` IL-"'- ❑OIIT-0E-6ERWCE WELL • ❑DEORIY61CnL WEU.a . y.,,..❑ 601E BORING B ` ❑GE6ER�VC�T1pN: TYPE OF WELL CI,; cmoi6 C FICATIONt 13 INDUSTRIAL 1 .0./OPEN BOTTOM DIA.OF VDRL EXCAVATION �� A El KORA IL PAcgBREp TYPE OF f.A81N0IBTEEUPVC DIA.OF CONDUCTORCASIM D/ yG DIA.OF WELL CASINO V r ❑PIIOIICMUMm CmAI ❑pVfN DEPTH OF GROUT SEAL SOI ID i� F -yam L YUT URRIGATMNIAO ❑OTHER GROW SEAL INSTALLEDBRFaFIcaTION R L7 rSBRAND NAME KCIF BY CjUL/ F(.ny—rj C€'h+C•A—rt 1 ❑ MONITORING p GROUT SEAL PUMPED:14vm ❑Ne E j APPENDS.OEFTHI' Z p CONCRETE PEDESTAL BY DNLLE!:� r ❑ Yr PROPOSED CONOS ��// S LOCRINO CHESTER BOXISTOW FEE,_TeUCt10N/dOlVNO AHDD: MUD ROTARY/ Alfl gpTAM ,I AUGER CABLE OTHER 1 I HE4BY CERTIFY THAT I IIgVE PREPARED THIS APPLICANON wNp THAT THE WOTF(WILL BE GONE IN ACCOROANCF vnTN BAN JOApUIN CDUNTY OPDINANCfB,STATE UWe,AND RULES AND THIS PERMIT 10�THEBANJOAWIN COUNTY, HOME OWNfP Oq IICEN6Eb ApEM'S 6GNgT11RE CERTIFIES THE FOLLOWING:'1 CERTIFY THAT NTHERRFOgMANCE OF 111E WOPK FOq WHICH THIS PERMIT IS LbBVEb.1 BIIALL IEOT EMPLOY PEA IONS SUBJECT TO WORKMAN'S COMMOANON LAWS OF CALIFORNIA.' CONEAACTOIT9 HIRING Oq 9URLONTNACTNO IS5 Wo URE R MII H THE FOIIOWIIfpI •I CERTIFY THAT IN TIIE PERFORMANCE OF THE N,M FOR WHICH THIS PENATP 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO ua-cWORoHA,,c CGI SIONA NON LAWS OF CALIFORNIA.-/T��HfF ''`'CgFIJ MU T CALL ZA 1GUp IN AOVAMCE FOq ALL REQUIRED INEPECNONE AT 1M 11M-f1]t, COMPLETE GNAWING AT LOWER AREA PROMM p 9yA.a z /'E%L /��.T nGp D(.I/II..�j2 3-30— 17 1� I D.I. 4I ROT FUN(0,.w,.Soo,Be.I. 'le I. NAMES OF 91"gEUS 0R ROADS NEAREST M OR BOUNDING THE Rb1ERfY, - t. OUTLINE OF TSIF PROPERTY,OIW"DIMENSIONS AND NORTH DIHECTON. I. LOCATION OF HOUSE BEWAGE U19MBAL SYSTEM OR PROPOSED ]. DIMENSIONRES,JDVTLNF.e AND LOCATION OF qtl E%IBTING AND AIOPO6E0 EXPANSION OF SEWAGE DISPOSAL BYBTFM6. STRUCTURES,NLLUOINO COVERED AREAS HUGH AS PATIOS,OPoVEWAYB,AND WALRS. S. LOCATION OF T,O ADJOINING MOND PE TY. UNDRED FlFTV FT. O PROPERTY Ofl DJO .u. •yA/• I S .- eE' PROPERTY. . .... . ........... may: h , m yyo aVF eg7r .�. .. .: . .rkbeing rxe :.... .. .....� ...i. .. :...........:..... ..... :.....i.....�.......i..... : : :. . ... .....:_...P.... . ........q.....:.... ' ..i.... V ' .......try ... a.....:.....�......�.....P......�..... : - a. ...:.. ..:.... ...........<......a 4.. < i....o-.....;....,a......:. 1 .... ..:..... «...........i. 1 :. MAR 11997, _ � i r. •-�-E,x;ras;aaL�a-ssaad �� r � f . PUBLIC HEALTH SEf?UiCES I 1 OV ,,"T UBS ONLY - 1 ApPllvHlen Ame oM—By ' 7 P,P„p I:.p.en.n ey OmrmWn Im0`IIe iI BY_ 3148/ W/r'on 3[�,3�_7 �'i. 1 �M ,..: I Q. r •� � 6/i?/sp � r�DoV 303 I6�, 1 wcc0ugngO QNcvn aD/ FACE /or i<f a4l-CS/. S1 ,VLi'p(,/)f(q/{,'c OE COOEt FEE INFO gMO11HTgA11TTFb CHECK I Gell PECDVEO BY GATE11 PEMRTIt91VICt PEOVdT NURR9i INVQI[E n _ 1