Laserfiche WebLink
APPLICATION FnR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> A.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON. CA 95201388 <br /> (209( 468.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICoAlplals IR Trit 6catfl <br /> lPrLICATION 15 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A r'ERMIT TO CONSTRUCT ANWOR INSTALL THE WORK DESCRIBED.THis APPL1CA71ON IS MADE IN COMPLIANCE WHH SAN <br /> JOAOUIN COUNTY 13EVELOPIMEENT TITLE.CHAPTER EI-1115.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> OB ADORESSAIR APHI ! 1 Ve_rnr, 1,5 _jRj <br /> CITI /1 PARCEL SIlEIAtrif Q p +� ^1 <br /> Fi <br /> WN£R'S NAME ADhREFS O 3••7 ? ?9e4 <br /> L A C/` . PHONE f_-__ <br /> CONTRACTOR I e GT , . ADDRESS D UCf yS3 g6�TY IOHF 1 35--tUI y <br /> �UB CQNTRACTOR ADDAF 55 UCf PI LONE f <br /> TYPE DF WELUPUMP: ❑ NEW WELL ❑ REPLACEMFNT WELL ❑ MoNIrOOINO WELL f ❑ OTHER <br /> r ❑ <br /> INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL f J <br /> New L4TRwslr }I,p-�` DEPTH PUMP SCT FT. FIRST WATER LEVEL p <br /> ITYPE OF PVMPI <br /> ❑ OUT-OF SERVICE WF.LL ❑ OE(]NfY8iCAl WELL f ❑ SOIL SORINO <br /> �1 DE6TRUCYION: � <br /> I"TENDED U6E TYPE OF WELL CONSTBUCIION SPECIFICATIONS <br /> rDO <br /> USTRIAL ❑OPENBOTTOM DFA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASIrIG 17 <br /> MESTICII"VATE ❑GRAVEL PACKIRI7E TYPE OF CASINOlSTFFIlPVC DIA.OF WF.LI.CASING D <br /> EiClMUNICIPAL ❑DRIVEN D IMI OF GROUT SEAL SPECIFICATION A <br /> ❑ IRRIGATK7NIAG ❑OTHER GROUT SEAL INSTALLED BY <br /> GROUT BRAND NAME E `� <br /> MONITORING GROAT FFAL I'll"PFD: ❑V_ [IN. CONCRETE PEDESTAL BY DFSI_LfR-❑Y.. (IN.N. s `` <br /> PRO X.DEPTH LOCKING CHESTER BOXtATOVE PIPE s <br /> PROPOSED CONlTRUCTIONIMLUNG METHOD: MUD ROTARY AIR MIA" AUGER CABLE OTHER <br /> E9E I CERT1i-':THAT 1 IIAVE PREPARED THIS APPLICATION AND THAT TIIE WOW WILL BE OONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY OT7OINANCEB,STATE LAWS,AND RULES AND <br /> GIriATIONS OF THE SAN JOAOUIN COUNTY. HOME OWNER OR LICENSED AOFNT'S SIGNATURE CERTIFIES THE FOLLOWING:-1 CERTIFY THAT IN THE PERFORMANCE OF TIIE WORK FOR WIIICII <br /> 16 PERMIT IB ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRLNG OR SUR-CONTRACTINO SIGNATURE CERTIFIES <br /> F <br /> TIIE FOLLOWING: 'I CERTIFY THAT 1N THE PERFORMANCE OF THE WORK FOR WHICIT TIIIR PE.RLATT IS ISSUED.1 SHALL EMPLOY 14R60N6 SUBJECT TO WORKWIAN'0 COMPENSATION LAWS OF <br /> CALIFORNIA.• THE APPLICANT MUST CALL 24 MOUR0 IN ADVANCE FOR ALL REQUIRED INS T10N4 AT 12001 4 011-34 2 ' COMPLETE DRAWING AT LOWER AREA PROVIDF,O, j <br /> • y QL l� <br /> and X 10 Tlrlw bds, /o a� •'! ![J <br /> PLOT PLAN ID.`w to Sad.)Sed. •to <br /> T. NAMES OF STREETS OR ROADS NEAREBr 70 OR BOUNCING TIM PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROTYTSED <br /> FOUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF 6EWAOE DISPOSAL 8YBTFfA6. <br /> DIMENSIONED OUTLINF9 AND LOCATION OrALLEXISTING AND PROMAEO S, LOCATION OF WFLLS WITHIN RADIUS OF ONE HIINRRED Fir TY rT. <br /> STAUCTUAEG.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> � 1 <br /> v <br /> Z' <br /> :��� <br /> ok <br /> i� Ll <br />