Laserfiche WebLink
APPLICATION FOR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SEAVICEB <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388,304 EAST WEBER AVENUE.STOCKTON.CA 95201388 <br /> (209)468 7420 <br /> PON REFUNDABLE,PERMIT tKPIRE3 1 YEAR F84M DATE ISSUED <br /> ATOM NS PERE BY IGmpIN4 In TiOtIm NI <br /> LIAbE 70 THE CH PIER 9 1 COUNTY FOR A HERMIT TO CONNTFMT ANUMIR INSTALL THE WOR(DEOCRIBED TINS APPLICATION W MAbF IN COMPLIANCE WITH BAN <br /> COIMrEY OEVEEURAENf TITLE <br /> CHAPTER/9 1115 9µp THE WANDAPI"OF BAN JDAOIAN COU�N/E rUBLFC HEALTH SERVICES.ETNIRONMENEAL HEALTH OMNI" <br /> JON ADORFSSMR APNf Kt L-4/ CTI I/UL I PIIMf,EL itYFJJ1FN/ <br /> OWNERV FRAME �� <br /> ADORESi SI' S• .� /n Vr�r/ P! !C 7�69�yri•/Z r-ur-.ZZ ry <br /> R .hIAC �} <br /> L ,r,J ",CONTRACT AaDEss 717 <br /> aNNeDNrRAcroRl {LLi. Abp1Ew371f L�icFrJs '/7��nwNE�9/L�LSY 7176 <br /> CI NEW WELL ❑REPLACEMENTWELL NIIOPIRO WELL N � 13OTHER <br /> 11 NIBTALTATION ❑WELL SYSTEM IMPAIR C1IONSSONNRECT REPAIR ❑VAPOR EXTRACTION WELL F J <br /> �r i <br /> (TYPE OF PUMy ❑ O � Hr DEVIH PUMP NET_FT FIRST WATER LFVEL <br /> ❑OVTar SERVICE WELL ❑aEOPHYSICAL WELL.N ❑ sOK somma S <br /> (�bEETISICTIORF <br /> N ENOEO VE <br /> ❑ ❑ W <br /> CONSTRUCTION iPNA OM■ <br /> BOTTOM <br /> S] WRAL N � <br /> VIA.Of WELL EXCAVATION Y OIA OF CONDMIORCAINNO D <br /> ❑bOMTSTORNVATE ❑ORAWL PACKINDE TYPE OF CASINGMTEEUPVC V CIA OF WELL CASINO p <br /> ❑PLISUCAMNIOWAL ❑oNYEN DEPTH OF..IT SEAL_ sPECIFICATION R <br /> ❑PROATIONVAD ❑OTHER GROUT SEAL INSTALLED BY OROUT SIAM NAME E <br /> 0LIOPNTORIMO OROVT TEAL f .1PUMPED [IVw ❑N. CONCRETE PEDESTAL 6Y ORL1LIh❑Yw ❑Nr O <br /> APlIIOIL DEPTHLOCKBFO CHEWER BOXmOV!RPE S <br /> PROPOSEN CONSTINPCTIONIDNLLLNO METHOD MUD ROTARY AIR ROTARY AUOER X CHILE OTHER _ <br /> 'HERBY CERTIFYT"AT 1 HAVE PREPAREO TTNB APPLICATION ANO THAT THF LNOIBC WILL BE NONE IN ACCOFIDANCE WITHH OAN JOAW W COUNTY OROINANCES WASE LAWS AND RULER AHO <br /> WatTHIN A %OF THE NAN JOAOIAN COUNTY NOME OWRlTR OR LICENSED AGENT s SIGNATURE CERiNNB THE FOlLO4NNa 7 CEWOY THAT MI 711E PERrORMANCE OF THE WORC FOR RV IT <br /> TENS PERWT M 1SWEO I NHALL NOT EMPLOY PERNONS SUBJECT TO WORKMAN N COMPENSATION LAWS OF CALUORNIA. CONTRACTOR S HIRINO DR VU"ONTRACTINO UMATURE CERHFIEN <br /> TNF FOLLOY"M I C:EJLTNY THAT IN THE PERFONAANCE OF THE VM]RC FOR VrM "THIN PEPIACT IN ISNUEb 1 SHALL EMPLOY PERSOHG SUBJECT TO WORKMAN s COMPENSA71oN <br /> CALNFp1yS 11S APPLICANT MUST CALL S4 HOURS IN ADVANCE FOR ALL REWIRED INSPEC"ON[/S_/A/T I:oNl4S11,4K27 COMPLETE p/µ/WRNS AT LOWLAWS OF <br /> ER AREA PRD D <br /> Mw.d X 7 Tld. Sri• F`T /G / T <br /> PLOT►LAN NN.w 1.S•�•I Ne.l• 1. <br /> L NAMES MSTREET/OR hOADS NEAREST TO OR POUNDING THE PROPERY 4 LOCATION OF HOUNE SEWAGE DISPOSAL SYWEM OR PROPOSED <br /> ! OURMPE OF THE P7OP My OIYNPO 11MENSIONS AND NORTH DIRECTION EXPANSION OF SEWAGE DISPOSAL SYSTEMS <br /> _.DSAENNIONED OUTLNFO AND LOCATION OF ALL EXIWNG AND PROPOSEO S LOCATION OF VVELLS WITHIN RAM*OF ONE RLMOVIED FIFTY FT <br /> WPBJCTURES.V CLUDL40 COVERED AREAN RICH AN PATIOS.bMVEWAYO AND WALKS ON THE PROPERTY OR ADJONINCO RRopg" <br /> o c < o > s e < <br /> 0 0 1 c r <br /> o F a <br /> a o > < < o e s a <br /> i <br /> DEPARTMENT VON ONLY <br /> ArrS.•inl AwNPt•S N ' ON. <br /> OewM MMP••IINA Br D.a P'-w%~h-BY bm. <br /> Uwlnell.n*.F••14A <br /> cwww.,1.•_.�t4,'�1 1G_ � !�fry<c;rf_- r•.c t ,.z�-- ,�7r;�Tid r ,C+ � r�x �..._ .,.. .� <br /> ACCOUNTING ONLYI ANV FACS <br /> FiX tMFO` PA40UW REMITTED CHEC FCANN RFCDVED BY OA ►EMIfNIFJ1VIC4 REQUEST NUMSp1 INVOICE <br /> Pub ANNUL 8m Emlro 173(31861 <br />