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APPLICATION FOR 1NELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388, 446 N.SAN JOAQUIN ST, STOCKTON,CA 66201.388 <br /> (208)461.3420 <br /> NO•RE I ABLE PEAWr EXPIRES 4 YEAR FROM HATE ISSUED <br /> mw*bo W Tripinw <br /> APPLICATION 18 HERE NY MADE TO THE SAN JOAQUIN COUNTY FOR A PEr W I TO CONSTRUCT ANDIOR MMTALL THE WWK DESCRIBED.THIS APPLICATION IS MADE IN COLWLiANCE WITH SAN <br /> JOAOLBN COUNTY DEVEIAPNENT TITLE,CHAPTER 9-1115.3 AND THE STANDA/bD8 OF SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,BANK MNENTAL HEALTH DIVISION. <br /> JOB ADDREMM APNI AAM- -m d CITY n RA/TR PARCEL SMAP t /� <br /> GONER'S NAME aawcrS /w A// A0011EBB_ -�•p.9�/�� C�9P p3 0 042—(Ests, <br /> r �'LI/ MHOREBS TLil <br /> an ADWEN e at CA LICK PHONE <br /> FI i CI NEWWELL CI RE'LACmmawELL C] MGNvrommWELL. D OTHER <br /> CI INSTALLATION C)WELL SYSTEM REPAIR 0 CROS"ONNECT REPASS ❑ VAPOR EXTRACTION WELL i J <br /> 17 Now C3 now HP. DEPTH PUMP SET FT. RESET WATER LEVEL O <br /> (TYPE OF PUMP) <br /> ❑OUT-oH*m ICE WELL C]GEOPHYSICAL WELL NH 13 SOIL BORING R <br /> OEiTIE1C'T1DN: � M �► <br /> A <br /> E3 MID mm4L ❑OPEN BOTTOM DM.OF WELL EXCAVATION OLA.OF CONDUCTOR CASING D <br /> 13 DOMESTICRPRVATE [3 GRAVEL PACIUSI2E TYPE OF CA8Mi018`EEIJPYG DIA.OF WELL D <br /> ❑ mmmmjwwAL ❑omm DEPTH OP GROUT REAL SPECIRICATHON Mo R <br /> O 1IRREGATIINIAO 13 OTHER GROUT SEAL INSTALLED BY GROUT BRAND NAME E <br /> ❑MDMTowNXH GROUT SEAL PUMPED: 0 Y. 13 No CONCRETE PEDEB'TALBy Dwm-13Y.. 0 N. S <br /> APPrnX.oLIPrN LACKING CHESTER BOXAITOVE PIPE Ni <br /> ROPOSED COMSTRLICTIONAIRRA W METHOD: MUD ROTARY AIR ROTARY AUGER_CABLE OTHER- <br /> -I H EF=Y CERHFY THAT 1 HAVE PREPARED THIS TION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUIN COUNTY OIbINAPK i,STATE LAWS,AND RRRES AND <br /> REBULAMONS OF THE SAN JOAQUIN COUNTY. NOME OWNER OR LICENSED AGENT'S SONATU E CERTIFIES THE FOLLOWING:11 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PUNW IS I SHALL NOT EMPLOY PqpDNS SUBAZT TO WOMMAN'S COMPENSATION LAWS OF CALMORSA.• CONTRACTOR'S WISING OR SUB-CONTRACTING 1BONATURE CERTIFIES <br /> THE POLLB: ESTIFY THAT LN THE <br /> ORAMIR7OF TFIE WORK FOR WHICH THIS PEISdIT M ISSUED.1 SHALL ENrPR.OY PERSONS SUBJECT TO WDIBLMAN'S CONrEr <br /> P8AT10N LAWS OF <br /> CAUFORI N . ANM FOR ALL I" I 10169PTIONS <br /> /J AT U1001 U>'SSI CCOO�MR EET}E DRAWING AT LOWER AREA PRO <br /> Ew+•d X TI1I. /i-4�+�/yl G V I MM Q <br /> H <br /> PLOT PLAN ron.w m eaYH Ba.N. / •m <br /> 60 ' <br /> 1. NAILER OF STENS OR M4=NEAREST TO OR MOUNDING THE PROPERTY. 4. LOCATIQN OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE FRHOPERTY,91VINB ON 03NIWNS MID NORTH DtlECTIOH. EXPANSIQN OF SEWAGE DISPOSAL SYSTREIB. <br /> 3. P001140HONER OUTLIES AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADARS OF ONE HUNDRED FITY Pr <br /> 8TRUCTURM NCUDINB COVERT D AREAS SUCH AS PATIO.DRIVEWAYS.AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> 77 <br /> .... ... 1 . <br /> ... <br /> ...... <br /> OAF Eck <br /> .. t ....... . <br /> I <br /> ...................... .............. ....... .... ..... <br /> .......... ...... <br /> ...... .... <br /> ...................... <br /> .............. <br /> ................................... <br /> ...... ....... .............................. <br /> ............ ....... .................... <br /> .......... ............. <br /> ... ........ <br /> .............. <br /> .. ......... ......... ....... :... .... :....:.. . <br /> .......... <br /> ... <br /> 4 <br /> .... ..... ;.. <br /> .. .. - <br /> .... . � . <br /> :.. _ - <br /> ..... ..... - ---.- - ... ... ... -- <br /> .:.... .. <br /> DommEUT on ONLY <br /> 7 <br /> .. r AppSeMi.n Aea.po.d OY 1 jr <br /> am"hupmftn By Dam `•cq— PMP Mrpwtlen 61I DM. <br />