Laserfiche WebLink
\ APPLICATION FOR WELVI UMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ..w <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 308,445 N.SAN 12091683 0UT. ,STOCKTON,CA 99201358 <br /> NON.REFUNOABLE PERMIT EXPIRES I YEAR FROM BATE ISSOEB <br /> B TT ---LPI <br /> AN <br /> J PO OV NICOVNry pEVELORAENTT ITIS,SANjOERB111OUNTyFFO A FEEMIT TO NOARO60F6ANCT ANDOR AOUNLIOSHHTY MSLIiAM THE C HEALTH 6ERNCE6MEBNAROMENTAL NGLTHIMNSMN .ANCE WITH <br /> IOMOPbb I <br /> 16.3 <br /> 3 N. Filbert Street CITY StocktonC ^^ PADf�{EL SIzoArNP APPppp• 5 ACR. ' <br /> JO.ADDRE66roR APNF 1 �.51VL (iF'..IP•mo 'J'ffl�J <br /> RI) <br /> I- - C, n /T�DF.6 ei PHONE, <br /> OWNER'.NAME NNb�E91 Pacheco CIL <br /> ADORES. Pacheco 485165 TwprvE Il5101603-271! <br /> CONTMCTOX <br /> ADDRESS LKI MONEI <br /> 606 CONTRACTOR <br /> AE1,� DIS-10 <br /> TYPE OF WELlM1MP: ®NEW WELL ❑PEFUCEMEM WELL ®MONHOWNO WELL I"" ❑OTHER N70DGS <br /> ❑INSTALLATION ❑WELL SYSTEM REPAIR ❑CR088{O..ECT REPAIR ❑VAIOREXtMCTIONWELLS 0 <br /> ❑N[w L311rpYr N.P. MFT.NMP 6ET�FT. FIRST WATER LEVEL ' O <br /> RYFEOFNMPI ❑ ❑ SIL SOME. B OIR-0FSERR <br /> NCE WELL ❑OEOrv6KAL WELL F <br /> ❑pN.GFUCTUD. <br /> IXIEXOED VBE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A <br /> 11 INDUSTRIAL ❑ORE.ROROM DIA,OF WELL EXCAVATION 8X ON.OF CONDUCTOR CASINO O <br /> ❑DOMESTICIPWVATE ❑OMVELPACX/AIE 2/12 TYFEOFCASUGRTEEU PVC MA.OF WELL CASINO 2 O <br /> ❑RIBUCMUMFG,AL ❑OWVEN OEFTHOFGROUTSFAL 63' SPECIFICATION R <br /> ❑IMS.ATIONIAG ❑OTHER GROUT DEAL INSTALLED BY Gregg Drilling GROUT BRAND NAME E <br /> [....NORMS ONO UT.EALNMRO:0V- ❑N. CONCMTFFEDESTALBYORUMERADYm OM 6 <br /> AF{gOX.DEEM LOCXINO CHESTER BOXAMOVE REE 6 <br /> REMEDIED CONSTRUCTION/MWNO METHOD: MVD FOTAIW AIR ROTARY AUGER K CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE FRERAREO TH16 APPLICATION ANp THAT THE WOR(WILL BE PONE IN ACCOPDANCE WITH BAN JOAQUIN COUNTY ORDINANCES,6TATF LAWS,AND RULE.AND <br /> REGULATION.OF THE SAN JOAGRN COUNTY. HOME OWNER OR LICENSED AGINTR M.NATURE CERTIFIES THE FOLLOWINO:'I CURTSEY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br /> THE.FERNIEF.MORIDIBBVED.I6NAUL NOT EMPLOY PERSONS.UBJICT TO WOEWAAN'S COMFMSATION LAWS OF CALIFORNIA.' CONTRACTOR'8 HIEING OR BUBLOMMCTINO SIGNATURE CERTIFIED <br /> THE FOLLOWING: CERTIFY THAT IN THE FERFOOAANCE OF THE WORK FOR WHICH THIS KRAFT 18 ISSUED.I-HALL EMPLOY EERMEM SUBJECT TO W.MUAAN'S COMEENIATON LAW.OF <br /> C.roAwLIFON_A /.MAUNLt AJ I. IN VLLOOU1FD ISFECIONS AT MIY2. <br /> COMPFTEDMWNp AT LOWER AREA AVMD.M <br /> TIa.3l;ZCir.go T szeFn DK._T-i T- 9S <br /> 0.0T FLAN 10-1,e ,6e.1._ <br /> 1. NAMES OF STREETS OR EOAO6 NEAREST TO OR BOUNDING THE NORRry. .. LOCATION OF HOUSE SEWAGE OISP08AL D,r1IM ON EIMM,D <br /> M <br /> 2.OUTLINE OF THE OMITTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> O. DIMENSIONED ONEM.E6 AND MFATON OF ALL EXISTING AND FGGMS 8 6. LOCATION OF WELL.WITHIN PAOIV6 OF ONE NVNppEp 11,FT. <br /> 6TRVCTURFD,INCLUDING COVERED AREAS SUCH A6 FATIO6,OOVEWAY6,AND WAIL(.. 1 ON THE MUMM r OR ADJOINING IyOFERTV. <br /> I <br /> I <br /> u <br /> d. <br /> CY l- <br /> FT LF3E RT ST RE t'T <br /> 41 T <br /> FAey A <br /> Q A <br /> 1"•Sti IU f <br /> tA <br /> SGhE6 'L VIS ISA � _ <br /> X <br /> I <br /> OFEARTMERT USE ONLY <br /> ARRIk.11.O A¢rglM Br� I .�-3 -`�S 9 4-y <br /> _DSM AIo <br /> ����//11 •a. L <br /> D.I. <br /> D.1. <br /> c.mm <br /> AC.DONnNO MNtr: upF FA61 <br /> PE CODn1 FEEINFO MAOUNTREANTTED CHECONCASN I "MOVED 8Y DATE POVAITRIEWICE REGAUT NUMBER INVOICE <br /> SG 'b 9D074 7Y 2 <br />