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APPLICATION FOR WELLJPUMP 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 /> NOTE-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> lCelRpl/DI M TFlpikEul <br /> APVLKATION IS 14TRE BY MAGE TO THE BAN JOAOUIN COUNTY TOR A PERMrT TO COFISTRUCT ANDIOR INStALL THE WORK btSCPISED.THIS APPLICATKIN IE MAGE O!COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TiTLE....CHAPTER B•1116.3 AND THE BTANOMgB OF SAN JOAOUIH COUNTY <br /> .PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH oMB10N. <br /> JOS AbbREBlAOR AAT/ 4 U�l�� C+{.� � � s Cfry,p`J`—.,K kay^ PARCEL SIZEIAPNR <br /> OVMER'S NMI, ,61' <br /> L✓�a1`q Ir{I'�FCY+I4•AAlA-�� �✓�M't�i]� � <br /> [OMAACIOR r41 , 1V•'-1S O`C1..L Cam!' kvix ATfb1�B!E�j�L,�, c� ��1�41,W� - Li]_ �/ 1 p .�E/1`NONEI L>^1 �• r-W7�� <br /> SIIB COMMCTOR <br /> HILL. ADDM88 fti'+SAJX�ti1b E�A UCr lZ�[� PNOHE�,?,�—L3"TS <br /> TYPE Of WELLMUMP V—WELL ❑Fir"CEMEwl WELL NMONROWNO WELL! 0I-y OTHER <br /> ❑INSTALLATION ❑WELL/YSTEM REPAIR [ICROSSLONWCT REPAIR LJ VAPOR EXTRACTION WELL R J <br /> ❑N.w[]RgeM H.P. DEPTH mwr SET•,_FF. FIRST WATER LEVEL O <br /> R YPE OF PUMA ❑ ROIL SONHO R <br /> []OVT-0FSERVICE WELL ClOEOAIYRICAL WELL/ <br /> ❑DESTRHC71oN- <br /> IRTEAOEO UsE 7YF�f OF W CONSIRUC 710H SPECIFLCATION3 YJAa <br /> ❑y INDUSTRIAL ❑OPEN iRTrtOM DIA.OF WELL EXCAVATION 4-))"( DIA.OF CONDUCTOR CARIM D <br /> III <br /> DOMEBTICIMVATE ❑-T ORAVEL PACK/S1TE TYPE OF CASINOMTEELIPVC TI`� DIA.OF WELL CALSIIN�O��`- 2 O <br /> 0 PV ucmuNICR'AL IBrJRAVEN DEPTH OF GROUT SEAL SPECIFICATION SF'T"'kuyti SL l�l�+ _ R <br /> ❑Esnio T10NMO 1907HER OROU7 SEAL IN19TAUFO1�B�YY VA4-L \'�+ OROUT BMNO NAME F <br /> �y OROUT SEAL PUMPED:JaT Yr ❑H. CONCRETE PECE9TAL OV DR?U FR:❑Yw fe S <br /> Ap MOMTONNO II40 OF <br /> FIN <br /> BfH cS LOCKING CHESTER BOXATO VE APE S <br /> ►ROPOsiD cONs TRUCTIONIMLL"M METHOD! MVD ROTARYAIR ROTARY AU OER CABLE OTHER- <br /> 1 HEREBY CEHTTFY THAT T HAVE PREPARED TMG APPLICATION AND THAT THE WOM WILL BE DONE M ACCORDANCE WIN SAN JOAOIJIN COUNTY OROINANCER,STATE LAWS,AND RALES AND <br /> REOIILATIONS OF THAT <br /> SAN JOAQUIN COUNTY.HOME OWMEN OR LICENSED AGEM'f BIOHATLIRE CERT WrES THE POt1.OWINOf'1 CERTIFY THAT M THE PERFORMANCE OF THE WOW FOM LMI[IT <br /> THIS PEAMIT IS ISSUED.I MSALLTROT EMPLOY PERSONS SUBJECT10 WORSSFAM'/COMPFJ4/AT/ON LAWS Of CALROAWA.'CONTRACTOR'S WFING OR MU CONTMCTIHO PONATURE CTRTIF9t* <br /> THE FOUOWINO: 'I CERtIFY THAT IN THE PERFORMANCE OF TME WORK FOR WHICH TWO PERMIr Is MOVED.1 SHAD EMPLOY PERSONS SUBJECT TO WORIBMAN f COMPENSATION TAWS OF <br /> CALIFORMA,' INC ARUcANT MUST CALL 24 MOUrEG IN AD�V1}A✓�NCI FOR ALL FMotwtb DFAPWMNS AT L70911�,14�p'1 4A,T7.COMNXTF DRAWING AT LOWER AREA PPq V10ED. <br /> ROT FUN 10—Ie R,.I.I R,.Ie '!O <br /> I.NAMES OF STRFFTG OR ROADS NEAREBT TO OR SOLINLMNO THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE 048POfAL fYSTEM OR AIOPOBEO <br /> }.OViLINE OF TN PROPEREY,GR NC bIMENSIONS AFRO NORTH DIRECTION. EXPANSION OF BEWARE CRSTV SAL SYSTXMf, <br /> 7.WMENSUNEb OUTUNF.s ARID LOCATION OF ALL EXISTING AND PROPOSED S.LOCATION OF VYELLG WAHIN RAOWS OF ONE HUNOR[O FIFTY FT. <br /> STRUCTURES,INCtU01NO COVERED AREIIG SUCH AS PATIOS,DFIVFWAYs,ANO WAIXB. ON THE FROM fY OR ADJORMaM PROE'ERFY. <br /> w L)a €^„ <br /> W9 4 U Z a <br /> &x7: Z`�¢ 4 O <br /> 9oLL <br /> 0 H d O n IL Z . <br /> o V 1 U <br /> o <br /> CO3 N f+ <br /> - �. •� m s 7 <br /> o as� <br /> g 5 <br /> cW Z ¢ Z a <br /> O <br /> � � 30 <br /> z � <br /> � z o <br /> • 4 46 e a <br /> £tl'LCSZ9'YS £ <br /> OE►MTMENT USE ONLY ARPBeHIm A-1.4 SY [ \ / on. Ar,. <br /> a—Mv.erbn SrjtI_I 4AII�efll, o.4N• 7� P-0IMbwllen BY, I�AA rfil^ o.t. L L <br /> O�w,nletlsn IrNPseebn eT 0.1. <br /> C e.nmsN.: <br /> ACCOIR4TMG ONLY: AIb1 FACE <br /> PF COOS FEE INTO AMOUIIT REMITTED f"Fc /ICASN RECEIVED fY DATE PDIN4MIERV10E NEOVEST NURRIM INV04CE <br /> 3S0 00 -[f6 .OD ✓ �� it <br />