Laserfiche WebLink
'4PPIWAIJON FOR vgi.L11'[IFAIp PERM13 <br /> GAN d0AQ0iN COUNTY PUBLIC HEALTH Sl;A'dIMi �n <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 300,445 N.BAN JCAQUIN ST.,SWOON,CA 0520140@ <br /> 1209)400 9420 411) <br /> unuteF11UDA@1 E DfRYIP EXPRIIII 1 TM MOM IIIA11 NSUM <br /> (Ca®P106 In MP;leAltl <br /> Acpllcat"an Ie hors by dada to the Sall Joegufn cvmcy'ior a porrLlt to construct and/or Irotelt th3 kork deoertbad. Th[d oppilcetlon is <br /> pada to cenpllsrre with Sen JONUIn County Devetoprrnt Title, Chapter 9-1TT5,� and the btandcirdt of Sen Jocquln Cosmty Public ROOM <br /> Services, Enviromtntet Health ofvlelcn, <br /> S'/do r.��: CI t)', � ' Par"ol Si✓.eIAPNi1 <br /> Job Adrlreaelar APHfI " <br /> ONnerre <br /> _T A�recs tic2J Phone g <br /> Co,�+troetar <br /> Sub Cortractor Adtlroo6 Llcp Phone V <br /> 11PE OF IA-ILLUNP: [I NEW DELL 1) REPLACEwENT WELL 11 WRITORING WELL Q, -__ (1 OTHER <br /> (I DESTRUCTION Oul:OF-SERVICE'WELL [I GEOPHTEICAL WELL 6 11 SOIL PARING <br /> )HSTALLATION (1 IffLL SYBTEH REPAIR O CRO5$-COBNECT REPAIR O VAPOR ERTRACYIOH WELL 9J, _ <br /> (I wev O Rcpa(r H.P. DEPTH PLOP SET FT. F1RST WATER LEVEL <br /> (TYPE DF PUM) .. <br /> 1NTEtl01D U9E; TYPE OF WfLt O STRUCT D D 8 <br /> (I IVWSIRIAL [) OPEN BOTTGA DIA. OF WELL I.XCAYATIO)1 0[A. OF [ONDllCTOR CA9INa <br /> p puKESTIC/PRIVATE [) GRAVEL PACY/SIZE TYPE OF CASIKG/STEEL/PVC _ DU. OF Mt. CA61NG <br /> (I PUBLIC/)a)NICTPAL [) DRIVEN DEPTH OF GRWT SEAL 60ECIFICATTON <br /> [1 1A41DATIooi/AD [1 oTNEft <br /> CRDUT SEAL INSTALLED DY GROUT BRAND NA}[E <br /> p )iCd11TORsua GROUT SEAL WOW: 11 Yes 11 No CONMETE PEDESTAL DY 02ILLERI 11 les 0 No <br /> APPROX.DEPTH_ LOcrteG CNI56TER Box/STOVE PIPE <br /> pnOPoDEO CDNSTRUCTiOd)DAIIIIDa EJETHOD: cola RDIART_Alp ROTARY_AUGER"CABLE,OTNER— <br /> ( hereby certify Chet [ have prepay this Opp cation and that the stork w t ba done in accordance WITh sen Joaquin County 8rdirw xu, <br /> 6tete leve, trxi Rules and Rrgulstiww Of the Son Joeq-1n Canty. Htme "mer or IScdysed agent's slgneturo cortlfiea the fCMPENSAT "1 <br /> certify that In the perf6rmruo of the work for wh1ch this per-It Is IeeuaJ, 1 $halt rwt uw(oy peraone sUBJett to WOR)OtAK'S CPerform—ce! <br /> Lout of Cellfornia." Controctorla hiring or sub-centrlotlnQraon'sub act tonatOre lUDAI)IA)t'sffes the TNNFEu9TioA Laus of Callfornla.�hT)fEAPPICANT4' <br /> of the work for mhleh thio Permit is "'cued, 1 sholl toptoy W ) <br /> MUST illl4iH34 id ADVANCE F`D�AII DUIFEO ItlsPFCTIOA y tl9)LtlD3A23, Ca+plote drawing at lower Byte provided. <br /> 7' — �l Title , Date_ <br /> X Sisrxd X <br /> PLOT PCA[ (Drew to $tele) §colo " to <br /> 4. Location of house Iowa;• drapesal system or <br /> 1. Netws of f the <br /> or raeae nearest to ar bo am N the property• ro ed expansion of aeve9e dtapalaL systems. Q` <br /> 2. outline of the Property, gIVINLocation dlmene"on' end Horth direclfon. P Pea <br /> 7. p(menaioncd o+tttlnee and location of all existing and proposed 5' Location <br /> BdJoltn"ing Property. 150 ft. <br /> Ftrmture6, Including eoverad ane' cuch BI patloa, driveways, <br /> Arta Welke. }-) <br /> MY 7W <br /> /r`t' U <br /> I i <br /> k 99 <br /> SA .I ACT tN .011 TV <br /> r TA H lY DIV (� <br /> J DIPARTIAEBT 116E ONLY <br /> Application Accepted By Dlat Area <br /> /D / a <br /> Dats pu-'� IMP—dm By <br /> Drout lnspectlon 8y �rt� _ <br /> Date Ctasacnts, A 4' <br /> r <br /> D et uctlon Inspection By ..(. 7/_cJf.r.,��`ft..-cs..l�r�o.•'� r v � . .. /T' <br /> - . <br /> ACCOURTIdG ONLY: AIDE FAC# k(/flrr�' +:k <br /> PE CODEN FEE 111F0 AnauHT AILJITTEO EC CASH RECEIYEO BY DATE PERBITFBERVICE MU 9 LU69BEA IwvO'CE <br /> &Zlot 01 <br /> S.E�' OCA <br />