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APPLICATION FOR WELLIPUMP PERIL 8@��'q FECEiv <br /> SAN JOAOUIN COUNTY PUBIiC HEAITq 8ERlTc�! <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ED <br /> P.O. BOX 988,304 EAST WEBER AVENUE/STOCKTON.CA serol-VAY 2 01999 <br /> (201145!•7420 <br /> 101.11MINOAKE PERMIT MMRE! 1 YEAR FROM BATE 1311IE0 ENVOX)NIMENTAt_ HEALTW <br /> rT �-. <br /> (C«IpIMn IM TT41NeW1W) .Rh,►IT/.�`,ERVIC <br /> I�•- <br /> MMSCATMU M'if'*SY MAGE TO THE PIAN JOAOIRIN COUNTY FOR A K MMV TO CONSTRUCT AND/OR M"Aft THE VMW fIESC"WV.TIM#APFUCATION IS MAM IN CIIN�(IAFICOE VRTII SAN <br /> JOAOIRN coumY"MoPMENT TITLE.OMPTER 0-1116.3 AND Till!STANDAIIM OF SAN JOAOLMN Coumv TIRSUC IIEA/ttlf SERVICES.ENVIIM)NMEMAL HEALT11 OMWION. <br /> JIH AMVMOR APN! _ /TSI g MAR.P�mILA p 1„C Ciro,-6-700( i]n/ rAncEL srzEiAFN► <br /> OVMNM'W NAME__111h1 <br /> CONTRACTOR,�s/.� -7lLI�t_..Y,�- Ams Ali CD 11OY39 <br /> SUN CON RACt011 WL.J ` i /r`L..r��.- ATIUIIFWW 'S-osn UC& n1oNeF <br /> D of WElMympl WNEw WELL ❑REPLACEMENT well <br /> w""NOTOMMwett"MOL-WIF ❑O111EII <br /> ❑maAl mom ❑WELt Wvetam REPAIR ❑CNOMMNWCT REPAMI ❑VAPOR ExTRACTION well F <br /> fTYPE OFF PUMM ❑N.rr❑nw* I.P. nervol PUMP SET FMIWT WATER LEVEL O <br /> (3 OUT-oF•SERvICE wR.l ❑OEO111VItMAL WELL I ❑ WOIL S01pi0 W <br /> ❑OEWiRUCt10►M <br /> ❑MMUSTWAL 0 O Bottom aA.OFWELLE%CAVATKNJ .W /f INA.OF CONDUCTORCASM10�/f O <br /> 13DOMESTICN"VATE �ORAVEL PACKM N TYPE CIF CASRNI/STFrVCE Mp UP _ VIA.OF WELL CAS7"" b <br /> E]FI.ICIMIMUNICIPAL /'❑onvEN DEPTH OF GROITT HEAL_ SQ-.35;- f WFECIFICATIDN_ScJI/ 'yt' M <br /> 13MrMOAT10N/AO ❑OtFR:R OROUT SEAL MCWTA'tFO BY_MU LO @� OROU►BRAND NAME E <br /> M <br /> ONITORING GROUT SEAL O`UK"O:(pKr ON. CONCRETE PfIIESTAL SY OIMLtr*..❑YM Elm. <br /> s <br /> I <br /> STN /iS Tf')g� tomo I CHESTER BO%MfOVF.PERE d <br /> PROPOSU CON T"M"GNMP W M METHOD: MUD ROTARY AM NOTARY ALWR_ 2cCABLE OTHEq <br /> 1 NE"EBY CMWY THAT 1 NAVE PREPARED TWO At"MATION AND THAT T►IE WOW WILL SE GONE IN ACCORDANCE WITH WAN JOAOUIN COUNTY OMWAU"S.STAT11 LAMIW.AND"MO AND <br /> REGULATIONS OF ria SAN JOAOIN►COUNTY. NOME OWNER OR tICENSM AGENT-*SMINATURE CER►KIES TIIE FOLLOWING1 h CERTIFY 194AT IN THE FEMORMANCE OF THE VM W FOR v"m <br /> TRW mmv WHO".I SNALL Not EMPLOY KR WM SUSJeCt TO WOMMAR'W COMPWNSATION LAWS OF CAUFOTMMA.• CONtRACt011'S►MISFIG OII SIN CONTRACtNM SMf1/ATURe CERTIFIES <br /> THE FinavAIMr '1 CINTIFY T M PERFOM>tAfs"OF THE WORK FOR VA CMI Vivo PERMT it ISIRM?O,1 MALL EMPLOY""NO/IW SUBJECT TO WOMI MAWS COMPONATION LAWS OF <br /> CALIFOISSA.' i1R T C !W fR/IMIW IN ADVANRE POR tU Of[OMM M0990"001111 AT f""44044". comMtTE OMWMN AT LOUVER AREA PIMIVINO. <br /> I <br /> PLOT PUN o w M*saw A.1. •N <br /> I. MANOF STIaEiS OR ROADS NEAfaST t0 OR SOIRIDNM T/IE P11D1 EITIY. •. LOCATION OF NOUN SEWAGE towagAt SYSTEM OR MIOPOSEO <br /> !. OUT of THE 10110MRTY.GlllSfS SMReNS1ONS AND NORTH OMIeCVMN. E%PANWION OF SEWAGE DO SAL SYSTEMS. <br /> s. von" moo OUTUNF.S AND tOCATIDN OF ALL E%NtMM AND PROPOSED S. LOCATION OF WELLS VVT1111►1 RAIMUS OF ONE NUNOIIED FIFTY FT. <br /> STRUCTURE NCWOSM COMM ARM SUCH AS PATIOS OTIIVEWAYS,AND WALLS. ON TNII PROPERTY ON ADJOINING FEIOPERTY. <br /> m <br /> A _ {• it- <br /> .d <br /> Is o <br /> I Y <br /> � <br /> 4.1 <br /> I <br /> .. awAkTfNE vUSEONIY <br /> AFFS.MI.n M.iptWd DF t•' t on. �i l' <br /> Or.ul Inq«II.w sF � ��O 7i �l" S Q-! •'' � I / f <br /> �N�MP.�Msn h � <br /> D..n,.M.R Inq.bMn sF Do* 7i l�yI �as� <br /> C .a.: Cuty <br /> AOCOUNTIM ONLVr AWPACT <br /> t_-s�11-, <br /> PE Dom FEE INFO AMOUNT f lm lls" At" "scow"BY SATE PBMIMTMlfIVICE WOINWT NUMSe1 111VOICE <br /> O s � v • <br /> Pub.H"M S*v..EnvNG.173 <br />