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APPLICATION FON WEWPUMP PERMIT } - 1604AN JOAOUNI COUNTY PUBLIC NEALTN SER E tI,, o P.O. BOXENYN MMNTAL NEALTN DIVISION 3M 304 EAV WElliq AVE NL% STOCKTON, aos� �o-aazo 96 0cr, L'F,^vi 1q-4t TE/ ��M I TUB b TrEM1EI SAN JOAOUMR COUNfA9M GATE!!=UE9 Q Py�•S/ AITLICATION IS HERE BY MADE TO THE TY PM A PE MIT TO CONSTRUCT ANDMA MrALL THE WOW DESCRIBED.THIS APPLICATION IS MAGE MH AMO MN MMTY DEVELOPMENTTTTM CHAPTM a 1115.8 AND THE STANDARDS OF SAN JOAGM COUNTY PUBLIC HEALTH SERVICES, COMPLIANCE WITH sow JOB ADOKSS0OR APIO�E 6c'i'>-ALLC ,y E�nIHo1NPARM HEALTH oMNON. OWNER'S NAME CITY�/tLIJ PMCEL SRE/APNI �y 1T,7�I r r Li j�C ADDME.. 20/ !1/F�r �7'tt SZ-- CONTRACTOIR.AT�PR 'Pr.. $ �'T�'RA.l�4�T- ADDI�p yPH�ONE.�7-lp/G� T Nc r LICI!;�-�G..mom s767 SUB CONTRACTOR ADDRESS PHONE= 1�OFwEu�L.M O NEW WELL O RBLAQEo,IET WELL MONITORING VmU O OTHER ❑ MSTALLATION ❑WELL Tamm REVANH CPOSS'CONNLICT REPAIR ❑ VAPOR EXTINCTION WELL Ewa O R.p* H.P. DEPTH PUMP SET FT. FIRST WATER REVEL (I'm OF PIMFI d O om oFSERVRCE WELL O GEOPHYSICAL WELL I ❑ am Down �OESTISICTIONe w • ©MIoLRM111At :... MOUTON DIA.OF W-LLVXCAVA•TION .7. DIA.OF CONDUCTOR AJIM p _ O OOMESTI MVATE L7 GRAVEL PAMANZE TYPE OF CAMMWWMAIVC_ f G DIA.OF WELL CASINO O PRlLIC1bmicPAL ❑LXVVEN DEPTH OF GROUT SEAL 9 SPECIRCATIOW C M wO0AT10WA0 O oTHEII GROUT SEAL METALLED sY GROUT!RAND NAME E DMioraw "`� r ' . oROLR SEAL PLmPEo:O Y. ON. CONCRETE PEDESTAL MYOIw1ER:O YS. O Ne s APPIOX LUMFTH ATO LOCKING CHESTER SOxnTTOVE PIPE s FROFOSo oeNSIIkI TRDNROREtIN4B MIND: MUD ROTARY AIH ROTAS AUGER CALRL OTHER 1 HER MY CNOW THAT T NAVE PEPAIED THIS AMMATION AND THAT'THE WO-W VOL ME OWI-M AI M EN SIDE WITH SAN JDAGUIN COUNTY OOMNANCMS ARID RULES AND IEOULATM OF THE GAN JOAOWN COUNTY.NOME OWNED OR UCDWM AGENT'S SNMTUM CETITFES THE POLLGWMIS:•1 CERTIFY THAT MH THE PpM'WN1 W n FOA WHICH TNM POMPW N@tl ,I SHALL NOT FoIIS SUMJECT TO WOIBOMAM S OOWNWATION LAWS OF CALMrOVMA•' CONTRACTOR'S HIRING OR SUIECOI��LSlMgTi N CERTNIEt THE •1 CMRTRPY THA THE F�OF THE WORK FOR VAN N THIS I'll"T N ISSUED,1 SHALL E V WY PERSONS SUBJECT TO WOIMLMA�'i TION IAYSe OF MSM ADVANO-8011 ALL AT IRON 440,422. COMPUTE DRAWMNS AT LOWER AREA PROVIDED. PDT PLAN prow b S..w S.MI. R. 1.,. ORL—MARBST TO OR SOUNOMNS THE PROPERTY. 4. LOCATION OF NOW KWAM DMML gyM M OII FROMM _. OIRiI>p FIgP1lUTY,SRVMIS DMMIORIS AND NORTH DETECTION. EXPAFI-ION OF Sl VME DINOMI.BVSTESAS. 3. AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF.1AELLs WITIMN S mm4w ONE HUNDRED PFTY PT Sf1E1CT1 r1 1 COVMM ARi111 VUCH AS PATIOS,DRIVEWAYS.AND WALKS. ON TRUE Pokwa.I OR ............?......r...................i.... .. .. .. .. .. .. .. .. .............. .. .. ..i... :.......`.... .. ;..: ..: . ji CgZ �.....¢......: ..:�.............•............. t. ......:......'..... .. .. .. .. ¢ i ..{... ..:. ....i;.. ..:.. .. ..................... .. .. .. .. ..:.....;•... ..: it.. ..{... ...:}...... { •. ..y::....�............:......i......:......{.......:...... .. ....p....:.:.... .. .. .. .. .. .. .. .. ..'..:.. ..v....�.... .:e.. ..... ..$... ....f......c.... .....i......:.......:.......;......%.......;......:.............i.... .. .. .. .. .. .. .. .. F. : j.. .............4............. y.w.6+ :...:......y....:.;.:...c .., q...c �.„ .............y......',.......i...... ......:......a......i......a......E.............i......Q......i....... .............y......i...... ......: :......:...........................{.•.....:......t............ :.p......:.... .. .. .. .. .. .. .. .. .. .. .. .. .. ..i;.....:.... ..i... ..:.. .. ........:..............:......i;......%.............:.......}.......... .. .. .. .. .. ......... .. .. .. .. .. .. .T .:..:.............'......{.......:.... .. .. .. ...{.......:...... .. .. .. .. .. .. . .. .. ..n.. ..:.. ..;M1.. .. .. .. .. .. .... i;.. �............j......:.............:.......}.......... ...... .. ...;.......:.... .. .. .. .. .. .. .. .:.......:.:....;a......:......p......:.... .. ...{..............p.............p......:.... .. ....j......:.... .. .. .. .. .. ..y.....:......:}......:.............:......i;......:......{.......:.... .. .. .. .. .. .. .. ........... ............... ....:.. ..... •......:......:.......:...... .....•....... ...:.. .. .. .. .. .. .. : : : ...:......n.....:......:.......�..:.•......:......:.......:.... .. .. .. ......... .. .. .. .. .. .. ...}.. ..:.....{... ..:.....i ..... ..... ..�... ..:.. .. ........... .. ..i... ..%......:.......:......... .. .............n......:.............:.. .......:.....................•,.......:......;•.............:}... .. .. • .. .. .. .. .. .. ..:.....q.....�.....{... ..%.....{... ..p.. : : .._. a D-rA�TIwrNT ws oNlr . APFE•.Ibn 0, o lM b D.H. O Awi *mot lu.r«U m N OM. Pune brew” Sy orN. D.gn.u.e t I X ; ADOOUNRMIB ONLr: AHDO PACO FE COBES PW MEO AMOUNT RMTTr 40"ll OMAN 1ESE11e MV DATIL ROMMIT NUMSEI i