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• • <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> i I) 0 pEFUNDABIE PERMIT EXPIRE! 1 YEAR FROM DATE ISSUED <br /> TRlgIpRR1Rl <br /> APn I[.A7ION IR IIEnE BY MADE TO TIIE RAN JOA <br /> OVIPIN Cot) FOR A IEIRAIT TO CONRTITUCT ANOMM INRTAII 711E Wrlrw Of RCRIRED.1104 AMICAION 19 MAOF IN COMPLIANCE Milt RAIZ <br /> JOAQUIN COUNTY OEVEFOrnMENT MI.F.CNAME11 9-1115.3 AND TIIE 9TAPInAMR Of RAN JOAQUIN COUNTY/OINK IIFALTII RF.RVICER,ENVIRONMENTAL IIEALTII OMRIO/N, <br /> JOB AMRi Rein APNI f!'� r Q / PANEL <br /> O1Mlf R'B NAMf SfQ/1(����Q�•j�1�' AM)/IF9R__ <br /> --'-- "lowCONTRACT O n__H qc;�C( _ AOOIVRR '— <br /> RIIR COMMCTOn _UCI _n10NE I <br /> _Rgm_�r_ f t��r;�ts AQMIISR Man fic cA LI[I <br /> -- MIONE I <br /> lYrEOF WELLJPV-P• d NFW WFLL ❑nfn.ACFMFNT WELL d MO/l"OMM WELL I _ <br /> INPTAI ��Li(�-,�(/O <br /> ❑ UTbN d WEI I.RYRTFM"FAIR d CM99-CO NNFCT nfrAln LJ VAPOR FK TRACTION WELL/ <br /> ❑1l.w❑nwn•Ir 11�, OEP711n11Ar PE7 FT. IFVFI --� <br /> n v1E or nlMr� rIFU T WATFR--- --- <br /> "x d OUTAr-RFnVME WELL d nFONIV9I1AL WTI _L Id "Ott nOIR _ <br /> ll LT "OttNO e <br /> dOERT RlgT10 N:V h[ /'/M•U(�E„i}'{,j-j ( �"--�-e,r h'19.� IN q�Yr' { Vni ✓ink Un �1 <br /> INTENDED UFF 1YrF OF W CO NSTRI/C I ION SPfCIFICAIMNO J y'--1 <br /> d INMIRTRIAL ❑OREN RO TION '/ I1 r r A J— <br /> DIA,OF WFII EKr,AVA71nN� ____ DIA.Or tONDlIC 10R CARINR_jt D <br /> d 00 -VATE d11 n"WI.PACK/R17E__ TYrr Or CARINn/RIFFI/T-VC MA.OF WEtI CARINO �� <br /> EJ rum ICJMUlffCn•AL I 1 nmvFN /I ° <br /> OFPTII Of nMln'REAL SrECIrICATION 5(/1. U vC A ?` <br /> ❑bn10ATION/An d OTIMn nMUT RFAI.INBTAILEO RV OMVT RMNO NAME r Oti. <br /> El E <br /> Mn Mtn NNO OMUT SFAL nlM/'f D!d Yr d N. CONCrWtE PEOFGTAL RV ONLLFR:d Vw EIN. 5 <br /> APMOK.OFITII tOCKITM CIII9Tfn BOX/RTOVE FILE <br /> S <br /> PNOrolf"CONSTRIIC NONn11SLUN0 METHOD:MVO MTA"Y At"ROTARY_ AUOfR CARLF nT11r.R �\ <br /> 111ERERV CEOTITY TIIAI 1 NAVE rnEPATY.D 711111 ArnJCA1gN ANn"AT TIIE WORK WILL RE DOW IN ACCOMANCf WlrN BAN JOAQUIN COUNTY OOINANCES.9TATE IAWB.ANO TULFB ANO ' J <br /> "FOULATIONR OF TIM MAN JOAOUN COUNTY,IIOMF OWNIN On LICFNRFn AOFNT'S RIONATUIIE Cf RTNIER TIIE rOLLOWNO!'1 CERTIFY THAT N TIM/EWORMANCE OF 111E WORK rOR WIIICII <br /> IInR PERMIT IN IMP <br /> LIED, 1RON8 9L/RJFCT TO WORKMAN'S COMPENSATION tAW9 OF CAMORNIA.'COMMC.TOR'9 IIIISNO On OUR COM MClINO MONATURE C[RTIfIE9 \ <br /> 111E r0 OnMANCE Of III!WORK FOR WIIK;1/IIIIR 1'f tIMR IR IBBVEO.1 RIIALL EMPLOY"AC O R'BIIRJECT TO WORKMAN'S I"a RI NSANON LAWS OF <br /> CAI A.' TUMS IN ADVANCE EOR ALL R1O1RR1,INSIECTMNS AT 170SI ANJSFI.COMPLETE DMWINO AT LOWER ARRA rIONOFO. <br /> RI1rwI K 1. _TIII._S'-I tn-'f `��K-Ot, <br /> D.1—z'2--2,(-_9 <br /> PLOT PLAN la.w I•R—.1 R.N• In <br /> 1. NAMER Or RIOEFT9 OR MADS NEAVI RT 10 On ROUNMNO TIM PROMRTY. 4. LOCATION OF/b VRE REWAOE pRM9AL 9YIITfM ORKI <br /> IRR'OBED <br /> !. O.P.PIE OF TIIF MUM MY,OIVNM DIMFHRIONR AND MPUN DIRfCTIVN. E%PANBION OF REWAOF DI9MRAF 9Y9TEM9. <br /> RtR <br /> J. t,P RIONEO OUTUVf6 AND LOCATION OF ALL FKIRTPM AND T'1OPORM 1.LOCATION Or WEIU V MON RAVOL S OF ONE NIINMIEO FIFTY R. <br /> UCTUREB,NCLUIDWO COVERED AREAB SUCH A9 rAT1O9,DRIVEWAYS,ANO WALK 9, ON TIIE PROPERTY On ADJOINRM PNDPfRTy. <br /> i <br /> .F� <br /> ......... .. .. <br /> l <br /> I <br /> (P�'AYMIENI <br /> JUN 2 9 1998 <br /> I I�i''S f SAN JUHOIIINCtJl1N 1Y ' <br /> "LTH SERVICES <br /> ENVIRONMENTAL FIEALTH OIVIRI()N <br /> nrrARIN, T Uf ONLY <br /> APPlle.11,m A--1-4 By DM• 6 8 Arw <br /> nr•,A 1n.p.nll.n Rr O.1• �'//yP In.nnellen By Oi1F <br /> n..lrr.11nn Irwnrolbn Rv_ '7F ON• _ <br /> Cnmmw.l. <br /> ACCOUNTINO ONLY: AIOI 111CI <br /> OE CODES FEE INTO AMOUNT REMITTED C/IECKI/CAIN I RECEIVED RY DAFE P"IMITISUIVICE REQUEST NUMBER INVOICE <br /> nl —Q:?X Ul 6 _ <br /> �0 _�n,1T fry <br /> — --- <br /> B3 S I_ -Sc� 6JOr <br /> P,1h 4Ranh So- Ciro.173(1/97) <br />