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QUO <br /> � <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 93202 <br /> (244)468-3420 <br /> NOV-REFUNDABLE PERMIT PMRE3 1 TEAR FMA DATE 030ED <br /> O:Ew'lnF!.Tr+Rutq <br /> AFFt9CA7XM IS LYRE BY MADE TO 74EFAN JOAOVIN COUNTY TOR A PR pSLL <br /> 'ERm T To CONSTRUCT ANOJOTATHE WOW DESCRIBED.TEE APPLICATION 1E MAGE N COMPUANCE 1VNH SAN <br /> NT � <br /> JOAOUN COUNTY OFMOPMFNT TNU4 CHAPTER 9-111 S.3 MID THE ETANOAIFME OF SAN JDAGUIN COUNTY PUBLIC HEALTH Ee1VICEf.ENVNOIaNENTAX HEALTH OWNSIM. <br /> JOS ADDRESLORAPNO 7761 W. Undine Rd. CITY Stockton PARCEL MZFJAWM <br /> avaItA•EHAw Augusta-Bixler Farms AOp1E.. 7761 W, Undine Rd.. Stockton ,-,ONE.462-0208 <br /> COM, M:TOR Hennings Bros, Drilling Co..Inc. A.... 3588 Peelandale Modus. 290813..ot. 545-1185 <br /> 7w CONTRACTOR AOOIIEN L J l��UC._ PHONE. <br /> bPl OF WTLLFLAI► )01 NEW WELL ❑REPLJI.cILWW mLL ❑Ma—q:RSMa WELL. ❑OTHER <br /> ❑NNStALLATON ❑wtu SYSTEM RErANI ❑CHDFECOMIECT REPAMI ❑VAPOR EXS RACTION WtU 9 .1 <br /> ❑M..❑R-. N.P. DEPTH PUMP WT FT- FIRST WATER LEVEL O <br /> R YPE OF PVMPI <br /> ❑ovros-aEILYICEmu ❑atoPHrNRCALmu. ❑ eo1LEo1ND e <br /> ❑oENTRucTTMN_ <br /> ftNSTIAPtlick ApiciftcAttaki A <br /> ❑wDUSTIEK ❑oPENSOTTOM dA.OFmttEXCAVATION 1411 UTA.OfCONDUCTORCASSO Na D <br /> ❑COUISTICMVATE i3 O/AVEL PACKJSQE TYPE OF CANNm1STEEtA'NC PVC 04^-ofWELL CASMO 811 D <br /> 111 PUKX NUMCWAL 11DRNEN v DEPTH OF GROUT SEAL 50, _ SPECIFICATION 161 <br /> ICI NFEOATIONMG ❑OTMEII GROUT SEAL METALLED BY d r i 11 er_ GROUT FMAND HAMS ... <br /> ❑MOMTONHO OROUr SEAL PLNArEG:ElY— [I N. CONCRETE PEDESTAL W :ORIUJ O Y–IIM. a <br /> APPROX.00TH 1 5Q 1 tommm CHESTER SOXWOVE FIFE S <br /> PMPOSM COMETIUCTIONRIMU N MSTNOD: MUG ROTARV_X _NR NOTARY AUGSR_ CAMZ OTHER <br /> I HEREBY CERTIFY THAT 1 HAVE PTEPARFO THIN APPLICATION AND 7HAr TILE WONC WNL LIE DOIIE N ACCoIVAWN MATIF SAR JOAOIEq CGIIIIrY OROINAmme.RATE LAVH,AID RULn ANG, <br /> REGULATIONS Of THE NAM JOAOUIN COUN'Y,NOME OWNER OR LOC M W ACENT S SIGNATURE CEREIFRE THE FOLLOWM9e'1 CERTIFY THAT IN TILE PE/FOM.ANCE OF THE WONT FOR 104NIMM ' <br /> TNN N REEVED.I SHALL NOT EMKOY PEMJE <br /> OW OUSCT 70 WORKMAN'S COIMPBO <br /> NATN LAWS OF C FJ"WA.'COMRACTOR7ISISIN OR SULCOFRRACTWMINGNATU E CERTFES %1 <br /> THE I CERTIFY THAT M THE PEIE'OIE4ANC!OF THE WORN FOR WHICH TME POSMR If 100WJ.1 SNAIL EMPLOY PERMNS SLNNECT TO S ommAATS OOMPERNAM M LAWS 0A 6- <br /> CALFOMIIA.' APPLICANT 04011 CALL ADVA/ICS PON ALL REMIIRITO MSPSCTIONE AT 11091 408.64M COMPLETE ORAWNIS AT LOWER NEA PROVIDED. <br /> It TRP...- P Dme 11-4-9R <br /> 5-- <br /> PLC ...ti N..MI ENI. 'M I <br /> 1,NAMES OF ET N OR ROADS 10 OR SOUNOSm pERrY. 4.LOCATION OF HOUSE SEWAGE ONPIOSAL SYMM ON PA000SED <br /> 1.O1RUP!M TILE MY.ONNIG 04@MCNS AND NO 1:TION. EXPANEON OF IEWAGE DISPOSAL W EMS. <br /> 1.D/.ENSOHEO OUTLOWS AND LOCATION OP ALL tXISTI1m AND PROfOSEO E.LOCATION OF WELLS WTTIM MAIM OF ONE IIUDRED FIFTY PT. 7 <br /> 9TR UCTURER INCLUD9m COVERED AREAS SUCH M PATIOF,DPNVEWAV%AND WALXN. ON THE FROFWTY GR ADJU94M PROPIMY. <br /> - - - <br /> i <br /> •1 lilw� • <br /> • . . I1 A1.'1' <br /> Rel',{+c—r:.••. <br /> :.NOV 51998 <br /> oSARTIM�Rr w!alLr / <br /> A,pft~A...PIM NF <br /> GI..A& MINS h -� � A.P.whl.NT Ow. <br /> ACCOU,f7WG 011tri AIOJ FA171 <br /> K Copp FTE NNPO AMOUNT PIPAITTTO C ANN RNCOVTO BY I GAVE PEPROYME(VICE REOUNST MUMNSII IINSKS <br /> Leo <br /> 01-7 <br /> na ^.— ,.1 .I a0 <br />