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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVI.,� <br /> ENVIRONMENTAL HEALTH DIVISION - <br /> P 0 BOX 388, 446 N_SAN JOAQUIN ST, STOCKTON, CA 96201388 <br /> (2(191.4683420 <br /> NON-REFUNDABLE PERMIT IXPI—�RES 1 YEAR FROM DATE ISSUED <br /> APPUCATON W HERE BY MADETO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONS'TPoICT AN——A11 THE MW DESCPIDED.THIS ADTICATON I6 MADE IN COMPLIANCE WTf sAN <br /> JOAOUW COUNTY DEVELDIMENTTRIE CHAPTER 9-111$.3 AND THE STANDARDS OF SAN JOAOURR COUNTY RJBUC HEALTH SEAVIOES.ENVIRONMENTAL HEALTH DIVISION. <br /> JO6 ADaassOR AFw 5023 N. Flood RoadCITY Linden P,u10EL3�JAPNI��& <br /> OW'NER'S NAME Ramacher-Manufacturing ADDRE66_5023 N. Flood Road DIONE, f 904)A87-4815 <br /> CONTACTOR Gregg Drilling & Testing, Inc. Martinez, CA. 485165 <br /> UCP DJD„E,(510)313-580C <br /> SUB CONTRACTOR ADDRESS <br /> I.IC, DONE, <br /> TYPE OF WEll1R)MP ❑ NEW WELL ❑ REPLAC£MEM WELL - ❑ MONITOPoNO WE311 ❑OTHER <br /> G' ❑ INSTALLATION ❑WF31 SYSTEM REPNR ❑ Cib66LONNECT REp ❑ VA R EXTRALTNRNWEL., J <br /> ❑Naw❑Rgrir HP. DEPTH PUMP SET FT. FIRST WATER UE - O <br /> (TYPE OF PUMM <br /> ❑ OUTUF-SERVICE VhLt ❑ GEOPHYSOAL WFIII SOB WRm - g <br /> ❑DESTRUCTION: <br /> IKT04DED U.E TYPE OF ELL CONSTRUCTION M`ECRCATIONG q <br /> -' ❑ mus TWAL. 11 OPEN BOTTOM DIA.OF WELL EXCAVATION qA,OF CONDUCTOR CASING <br /> O <br /> _.❑ DOMESTICI VATE ❑GRAVEL P�E TYFE OF� pA OF WEU.CASwG - D <br /> D PUBLICIMUNICIPAL ❑OWVEH.,. - DEPTH OF GROUT SELL SPECIFICATION R <br /> '..-❑IRRIGATNI WAG ❑0 T GROW SEAL INSTALLID BY GROUT BMNO NAME [ <br /> ❑ MONRONNG GPDUT SEAL RIMPfD:❑YU []Ne CONCPEfEPEDE 11YDRLLFA❑Y- ❑Ne S <br /> vv APMOJL DEPIN EDCRING MESTER WO STOVE"m S <br /> PROPOSED CONSTRUCTIONA)MWNG METHOD: MUD ROTM AM ROTARY AUGER XX CABLE cTNER Geo-DrObe <br /> I HEREBY CERTIFYTHAT 1 HAVE P ABED THIS APPIJCATION AND THAT THE WOK WILL M:DONE IN ACCORDANCE NrtI11 SAN JOAMIIN COUNTY OREMNANCES,STATE UWS.AND RIMES MO <br /> PEGUUTONS OF THE SAN JOAOIIW COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOUJJVANG:1 CERTDY THAT W THE PDVOPA1NtE OFTHE WOW FOR Nm.CH <br /> THIS PERMIT IS ISSUED.I SHALL NOT EMRDY FERSON6 SUBJECT TO WORKMAN'S COMPENMTNIN TAWS OF CMIFORNIA.•COMM.CTOR'S HIRING OR SUB ONTR W MNATURE CERTIFIES <br /> THE FOLLOWING: -1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW.FOR WHICH THIS P ff IS ISSUED,1 SHALL EM0.DY PERSONS SUWER TO W ORICMAN'f COMPENSATION UN5 OF <br /> CAUFOIWIA.J'-E�THE CAMT MLKT1/C. 1t NOU1S IN ADVANCE FOR ALL REOIKRDR INMRCTpNy6,AT CWeI A 4M= COMPLETE DKAMNG AT IDWEH AREA PNNDED_ <br /> saI..KX .sV(2 �rYJc i” TBI. 17f O�Pc1 �Pno POIOQ iG� Dn. L2-!1.C/1S <br /> DINT PLAN I`EHT SOMI SUI.. 1 i1 •m 6D` _ <br /> 1_ NAMES OF$THEFTS OR ROADS HE NM TO OR BOUNDING THE PIIOP N. {. XPAN ON OF HOUSE SEWAGE d6FOSTE SYSTEM OR PROMISED <br /> 2. OUTLINE OF THE PfOpERTY.GNOJC DIMEN610N6 NIO NORTH DIRECi1pH. IXPANSNIN OF SEWAGE p6FV5K SYSTEMS. <br /> S. pIMFN6IONF0 OU TUNES AND UO TION OF ALL IXISTING AND P MSED S. UD TIQN OF WELL$W MDIUS OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES.IN=DING COVET®AREAS SUCH AS PATIOS,DRVEWAYS,ARID WA S. ON THE PIOPFR(Y OR A WING PROPORY. <br /> .'........ .. _ ,. <br /> //(�,•� DEPMTMFM YSE OMLT �J ('Ems/ 1y-lT' <br /> AOPFUtbn Acr NA BYIJL�✓""" _\yn <br /> Grana lr.panlon BY / Wm �t /� �PvnP K�Pacilen BY O.te <br /> De.Nwlien lU/}Jx�tion�BAY t� __-' +1T M�. <br /> KCOUNHNO ONLY: MIDI FAC) •O ' <br /> FE CODIM FEE INFO AMOUNT REMITTED HE N RWEVE➢SY DATE ,6NTISEImcE REOUELT NV.ISER INVOICE <br /> °� of 1 Z GTL- � 606$I- <br />