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APPLICATION FOr .IiL.r?UMP PER.NIIT <br /> SAN JOAQUIN COUNTY P ULILIS HEALTH SERVICES A <br /> :"jr ENVIRONMENTAL :IiALTH DIVISION <br /> 0 BOX 388, SAN JOA131111V ST, STOCXTON, CA "6201-}aa <br /> • 12041 4M34217 <br /> NSM RIF Il I1DABLF PEr1MiT :S PIR CS 3 YEAR FROM 04TF t5511(n <br /> AI'RLCATION IS fIEP@ RV MAV[TO 711E FAN JOA UIN LDa..TA). ICcmpMb a Tlplmmal --- .+ _ <br /> D PAUlrh cV.Ifti fAT1 <br /> nl.:.lr:v,._,. :;:All !HI Willi%UrbClcnlu lin::<n11CA71GN 1.4)AAl,F IN C4MA�SANCE <br /> JDApUIN COUNT-V iH VFLuPN[Ni 7PTLF,C/EAPI[A 9 i 115.7 ANO Tiff ST AN!`Allll:.�r!„vl: r.,Aillop.•r r]UFrrY FURY[)i[A1 III StRV.C1 S I).V11Y)NNIf NIAI IIIA(Tlt{X VISIUN <br /> ? JORADOA(SSronAfYeA ��-,_ ,/' jl7 A.�� 1)LI%r(� /[- <br /> -�:Y J' �f rvc <br /> rAfLIrAn.• <br /> : U <br /> I <br /> A'S NAME �'- 1S'Ff�ff �. <br /> ' —�.i.._..1-:�.�r:Y/�� •,rlrllr r.f:I l_IYI�J /��- l �i S ''l/ J <br /> 1 CONTW.TON--,L�-L.�.3-l_.F� - <br /> -L- ��__ _— __-„>I»;/„<.— V [-. (_11�,r f I r .lam• .�!'_ L_I,«1NF. ' -.2 - <br /> EURCONTRACTOR <br /> M,4llU rlb IAC, FYION[ <br /> TVP[OFA WtLI1PoPAR: ❑NEW WELL Rf Ft AC[M[Nr 1ti.11[L •. I r ('-7 { <br /> n AUN11UR1N<I YJE I[I_ - <br /> 1...1 <br /> INSTALLATION ❑Wr1L SYSTEM R[F'AIN 41 f.RFr iR COFJWCT FIEPAA'l -- ❑ VM-OA Ex TRACTION W'[YL f _ <br /> J <br /> 4TYK OF fUMpI ❑N �P.. IM'IP. — .)1 r11.SANT'c(7__I T, F <br /> IRST WATER LEvTL <br /> L/ <br /> OUT-OF-SLNViCr VITLL ©CIUrEIYKH;AI WFI.L A G 601E Pq wNa b <br /> DESTRUCTION: ---^” <br /> IN[FM�pE_f)111E TYPE OF WFL <br /> CONI TRIfC TION GI1(CIirCA T10 N• A <br /> ❑1NDUSTPoK ❑OP.N BOTTOM Y '1 <br /> DIA.OF wlil[x6AVA11U.N IAA.OF CONDUCTOR CASINOD r <br /> ��// <br /> OOMESTICIPRIVATF (70MVFL PACKr812F - V.)'F OF CASING,ST[fl;l'JC E'!' `— DIA OF WELL CASONG <br /> ❑PUSLOCAAUWDCIPK ❑DRIVEN [TERM OF GROUT SFAl s <br /> SPECIf IC AiIOk ,t y <br /> IRgWATbPVAC. LJ OTKFI GROUT FELL Ih6T Ai l l I)1--pIy�o (I'%.1t( '�I� GROUT tlRAND NAME_ ') "-�FP���!-II�/f-r /�//E , <br /> AONiTOPoNO GROUT SEK PUMPED T..f-r.. LJ N. cotic;w7t PEOESTK SY DARLEPI,]D-T.. ❑N. iI• <br /> APFP-x'OmN - LOCKING CHESTER SOxISTOVF PIPE S <br /> PROPOSED CO NSTRUCT1ONfDFU"NO METHOD: MUD ROTARY� AIR ROTAAY___ALATFR CAW OTHER <br /> 111EgEBY CEM1TIFY THAT 3 HAVE PREPARED TNIB AFELICA7 n]N AND THAT THF WOW NFILL Rf DON(1N ACCORDANCE WITH FAN JOAQfGN COUNTY OAWNANCFS,STATE LANK,AND RULES AND <br /> OFOULATIONS OF THE SAN JOAOUI HO OLV/:LIE OR 110ENSEO AGENT'b&GNAT URE CLRIIFIES THE FOLLOWING 'I CFFW.Y THAT IN THE PEPFOMAANCE OF THE WOR[FAR WHICH <br /> I This PERMIT IS ISRUED,ASN EMPLOY R NS 5UEUFCT TO WCTkKMAN-i COMPENSATION LAWS OF CALIFORNIA.' CONTTLACTOR'S MFr"Q GR SW lONTRACTINq"WATURE CERTIFIES <br /> ThE FO LLOLMN13 '10 1 HYl N T O E THE WORK FOR WHICH THIS MWAD if ISLU[D.1 SHALL EMPLOY F'EAWftS SURJFCT TO WCHWAAN-A CONUIEN&ATFON LAWS OF <br /> CALIfORNIA.' MW HO A410E FON ALL-AGLIP. TOak 9,A 711f'J� 'l. ETf 7LAWLI4 AT LONER AREA MTOVIDED. <br /> sw'raX 7 +}'� <br /> I POT FLAN ITN.w is frW.l Scw f F <br /> J' 7. NAMES OF 8TREt7S OR ROADS NEAREST TO OR ROUNDING THE PROPERTY. A. LOCATION Of HOUSE SEWAGE DI ?OeK 8\MM UR 7ROPOSEO �q <br /> Ir J. OUTLINE OF THE P10PEFT-,C-IM44 DIMENSIONS AND NORTH[NFHCTION. [xPwNSA(lN OF 6[WAGE DISPOSAL FEST{SIB, <br /> 7,DIMENSIONED OUTLINES AMP LOCATION OF AL'-EXISTiNO AND PAOFt)SED S. LOCATION OF WELL:WITMN RADIUS OF ONE HVNOF6D FIFTY FT. h <br /> STAUCI UAES,MCLOOING COVERED AAEAS SUCH AS PATIOS.DRTVFWAYS,ANO WALKS, <br /> ON THE RK)PTRTY OR AUX7[wNG PROPERTY, <br /> I <br />} I <br /> SEP 2 9 1995 <br /> r ti <br /> IE DEPAATMENT UST ONLY ) q <br /> F Applr OBn jAWmW d d, <br /> tw.' �� '1 L PL'•p I/roClrnn BY O.[. <br /> O4+rlslien m.p.ctrw.ll r O.r. <br /> ENING ONLY! MDF T I IAL:. <br /> I PIR COLTER FEB Iwo AMOUNT AFRNTTFO NFC lC AIH AFCDVTD BY D.T. PF71MI1:tOINCF....T IFLAAtp1 SNV.E <br /> � L i <br /> I <br /> 1-001 <br />