Laserfiche WebLink
— <br /> i <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICEF <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RO, BOX 388, 904 EAST WEBER AVENUE, STOCKTON, CA 95201380 - <br /> 1209) 4883420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> APPLICATION In HERE BY MADE TO THE RAN JOAQUIN COUNTY FOR A PERMIT TO CGNSTRuls IAND/OR INSTALL ALL THE WOW DESCRIBED. THIS APPLICATION Ie MADE IN COMPLIANCE WITH BAN <br /> JOAQUIN COUNTY DEVFLOPMEM�T/rtIf, CHAPTER B- 1115.3 ANO THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH REOVVICEB, ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADURESGION APNF N/�" / AJfs� Fj( 1T_ $^ Cj7xjai•/ PARCEL BMEum1 <br /> UMFnSNAME Cghinq (, rBQL�iB, ; B 'O cg DR mmsi/ECJ SG^r 9�I � gyouE 9NoJ� <br /> 1 <br /> CONTRACTOR Lr i Lo� SRF If 1 „ 1( DonEea PO S].0 .r, lA Rb �/S A LACE �A�E�9D g1oNE V �� <br /> SUB CDWMC ,�/ ADDRESSHCI PHONE If <br /> TYPEOF WELUPUMP: L3NEW WELL 11 REPIACEMFM WELL 1tl IAONrtonlNG WELL E*_ ❑ OTHER <br /> ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CPOBB-CONNECT REPAIR ❑ VAPOR EXTRACTION #E J <br /> ❑ Have 11npolr M.P. <br /> TYPE OT POMPI DEPTII PIMP SFT_R. TURBT WATER LEvvkO <br /> ❑ OUT OF SERVICE WELL ❑ GEOPHYSICAL WELL I ❑ BUIL PORI A <br /> ❑ <br /> DESTRUCTION: <br /> TYPE or WELL ONBTgUc,10N FCIEICA <br /> ❑ INDUSTRfflTENDRO IAL L1 GAIN POTTOM DIA. OF WELL EXCAVATIONrIo LY DIA. OF CONDUCTOR CASING AZA4 A <br /> ❑ DOM B 1 ARIVATE 0GMv LPACXMIPEoe{ CL TVPEOFCARINGASTFgmvc Du. of weu cAalxG p <br /> ❑./rpueucmTUNicIPnt ❑ owvEH DEPTH OF Gnour Bent +- 2S BPECGICATION&yA,U A <br /> 11 1DO MOINDon NGG OTHE9 GROUGROUT <br /> SEAL INGTAUEO BY Z7LlcL ' GROW BRAND NAME 7 E <br /> SEAL MMMb: w� CONCRETEMOEBTALRYDw <br /> APPROX. DE '�'6' LOCKING CHE"En ROXIATOVE FREE E <br /> PROPOSED CUHITAM"*NI LUND MIUMUM MUD MTAAY AIR POTARY AUGER_ �� CASLE OTHER <br /> 1 I HE9EBV CERTIFY THAT I HAVE PREPARfO THIS APLCATION AxD DIRT illE 4VDIK WILL SE DONE IN ACCOMANCE WITH SAN JOAOUIN COVNIV DMINANCEe, BfniE LAWS, AND gUIEB A <br /> REGULATIONS OE THE RAN JOAQUIN COUNTY. HOME OMER On UcRESEM AGENT'S SIGNATURE CERTIFIER THE FOLLOWING: '1 CERRIFYTHAT IN THE "FICA MANCE OF THE WOW ND <br /> POq WHICH <br /> iTHIS gRMN IB IGRUPO, 1911ALL NOT EMPLOY PERSONS SUBJECT TO WenXMAN'I COMPIMIATION LAWS OF CALIFORNIA' CONTRCTOR% HIMNO OR BUB-CONTRACTING SIONATURE CERTIFIER <br /> THE FOLLOWING: ' Fr TI TITN THE PEOF THE WOW Fen WHICH THIS MAKER IR MOVED, I SHALL EMPLOY PERSONS SUBJECT TO WORMAANY COMIFNRATOH LAWS OF <br /> CAUFORMA.' T CAµ 24 8 IN ADVANCE FOA ALL MINIMUM INSHOUGONI AT I2m14II 22. COMPLETE DRAWING AT LOWER AMA !PROVIDED. <br /> iWa / Ll -[! Title <br /> IMOT MN IUrex to Salol SuIEto yo e <br /> 1 . OB OF STREETS OR ROADS NEA ST TO OR ROUNO1NO THE PgPERTV. 4. LOCATION OF HOUSE BEARDS DISPOSAL SYSTEM On PROPOSED <br /> OUTLINE OF THE PROPERLY, GIVING DIMENSIONS AND HOOVER DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS, <br /> DIMENSIONED OMUNES ANO LOCATION OF ALL EXISTING AND PROPOREG 6. LOCATION OFWFLLB WPNIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> BTgUCTU1REe, INCLUDING COVERED AREAS CLASH AS PATIOS, DRIVEWAYS, AND WALKS. ON THE PROPERTY OR ADJOINING ggPERrY. <br /> Mw � <br /> bC1ATHOAI SHwvI <br /> O <br /> SAO 5 <br /> rOAU3 <br /> As�Pu RAw4 • o <br /> suL Nor” Ewrhac, wvLTrDa r� o <br /> rVAAI 'T44K - Er}.EE mw1 <br /> O ILLH7lo 3W� 0 <br /> ' LYo mwi - . <br /> O 4XISTia1/ AHoaITbzn* coeUs <br /> 6 4NoPosep . . A+orgr :aLA6- Rxc 00006`51551 <br /> STxAYW rAw2 <br /> - .. . _ . , <br /> OFF <br /> FN nTMBe ONLY <br /> APP n AaaeptaJ B ' vetoI L 5(7 <br /> Main Intonation By Dole <br /> orLmcon Iavallen By P Invowtion By <br /> Gets <br /> Commardo <br /> ACCOUNTING ONLY: AIDE PACO <br /> ME coon FORMED HT RDWRTFo ITEC OBVSO BY POWnTIR1VICE gcODUT XUMSRI INVOICE <br /> OVI <br /> Z <br />