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V?� <br /> APPLICATION FOR VLUMP PERMIT <br /> SAN .OAQUIN COUNTY PUBLIC HEALTH SERVICES MAYS 2 0 1999 <br /> ENVIRONMENTAL HEALTH DMSION f. <br /> x 304 EAST WEBER AVENUE,STOCKTON, <br /> (209) 46$-3420 <br /> N016REFURDABLE PERMIT EXPMM 1 YEAR FROM DATE ISSUED �' <br /> R i IL <br /> ICaBI¢ia[a in Triplieatal <br /> APPLICATION is HERE BY MADE TO THE SAN JOAOUMM COUNTY FOR A PUWr TO CONSTRUCT ANOIOR WMALL THE WORK DEaCFUWD.TIBS APPLICATION 18 MAGE IN COMPLJANCE WTI+SAN <br /> JOAOULN COUNTY oEVELOPmmr TILL CHA <br /> PTER 9-1 115.3 AND THE aTANOAms OF BAN JOAOUM COUNTY PuKc HEALTH SERVPCES.ENVILONMENTAL HEALTH OMSION. <br /> JOB AMM"MR APR# ,fQJU CfyyT��YJf,,���,",��y�I /,, ��/J�♦ �wCE1.91ZElAPMf . <br /> ONMrtR7 HAIJE 6� (�� AOOIIEta 47GTJ /DrF✓ ZJ .GD � <br /> At— P"O"E'r <br /> CONTRACTOR /I d AOOIIEBS rwJ7�. (cJ/LSd1J GtJ/f� LICf <br /> CO � � PHON%f — <br /> /—U�1/CPB���R2. i+1 AooPrtstTTY�.W <br /> PNOHs s <br /> Rua CONTilAC70R <br /> =OF� �NEW WELL ❑ Pon.A,pAEHr wELL ❑ MOI.1TpPM.O WELL f ❑ OTHER s <br /> . + ❑ mcrAILATRM7 ❑ WELL SVSTEM REPALR 0 C14090-CONNECT REPAIR ❑ VAPOR OVIRACTHM WELL f <br /> .. ❑N...C3 R-p.ir HP. ; a.. c DEPTH Pu%AA eET FT. F1MT WATER LEVEL - <br /> (TYPE OF PUMPI ❑ ow-cw-SERVICE wra ❑ OEOPHVSICAL WELL A M � Sm BoaNG I f <br /> ❑OEsTFucTmw- . <br /> INIQIaED 2s6 TIPS 9F WELL �„ CONaLTRICT1Ow sPECFlCAT�NS �� A <br /> ❑ iNwarmt. _ ❑OPEN BOT70M OUL OF WELL EXCAVATIONOIA OF CONDUCTOR CASING O <br /> ❑ oamer CRwvATE ©GRAVEL PAoum TYPE OF CASB-OwrEL/PVC. vV OM OF WELL CASwtG -/Z ., 0 <br /> NI <br /> ❑ Amic MUCIPAL 13ow m DEPTH OP GRDvT SEAL 96*' /O ' sPEC$ICJ1T10N w�77 A <br /> ❑ iRROATIONIAO ❑OTHER aaDUT SEAL*wAuEn BY:�rr�r.rsr/� GROVT BRAVO NAME /lJ/7C!/1fi E <br /> MOlITORWG OROVT SEAL PVMPE07❑Yw ®HP CONCJETE PFOESTAL SY OPaLLE1!❑Yr ❑Nr S <br /> APPROs.OWTH '1LY r L L/_ LOQONO CHESTER SONMOVE PUE ' �y_ S <br /> PROPOSED cONa7RUCT10klalStiiwO MSTMD: MW ROTARY AIR ROTARY AUOER__y, _CABLE OTHER <br /> 1 mraf3v CERTIFY THAT i HAVE PREPARED TWO APPLICATION AHO THAT THE%OW WVR.L Be DONE M ACCORDANCE W M RAN JOAKTUM COUNTY OROIIANCEN.STATE CAWS.ANO RUIE6 ANO <br /> M1EOULAT10N8 OF THE BAN JOACUM COUNTY. NOIRE OWNER OR L10ENOW AOEIT'N SIGNATURE CERTIFIES THE POLSOWWf1aP.--1 CERTIFY THAT M THE PEIFQIOAANCE OF THE WORK POR WNICII <br /> TWO PERMIT IB ISSUED.I BHAILL HOT EMPtAY PERIORM SUBJECI TO WKNRKMAIPN COMP9ISATIOW LAWS OF CALIFORNIA.' CONTRACTORS HIPOM OR SU6CD11TR ACTOM SIGNATURE CERTFIES <br /> - T CE FOLLOWING: -I CERRPY THAT IN THE PEIS°OFAMICE OF YW WORK FOR%%"CH TM PEIIMTT If IasUM.1 SHALL EMPLOY.PEFOMM IUBJECT TO WORIMAW S COMP916ATIOw LAWN OF- <br /> CALIPOFMRA.' CALL IK aT ADVAWCS FOR ALL NEOUM M INaPSCMFW AT rM"ASNia7l. COMPLETE ORAIPRIIG AT LOWER AREA PROVIDED. <br /> ahn+d X Y - O•n ZD �. <br /> ROT FLAW ZA t•a, 6e.Irr 'ti . <br /> 1. NAME@ OF STREETS OR ROADS NEAREST T SOLN10M0 711E PROPO Y. A. LOCATION OF HMM SEWAGE OINPONAL SYSTEM OR PROPOSED <br /> 2. OVTUNE OF THE F4IOPERIY.anANQ DIMENSIONS AND NOMM DIRECTION— ..r' - EXNANOON OF aEWADE atsmIAL NYSIEMS. - <br /> _ 3. DO&W 1OMD OVTIJPIF.S APB)LOCATUM OF AILL ERISTMO AND <br /> PRGPOaEO <br /> S. LOCATION OF VIIEL,L,S VMFfIM RAOR/i 9F ONE NIRIDPKO PIFTY FT. <br /> NTRUQTINES.SICIUJOM COVERW AREAS MICS AS PAMM ORVEWAM ANO WAIX& OM THE FFX)PEIRY OR AOJOINRIO PROPERTY. <br /> Z. <br /> KM►ART AMA U"OMY <br /> APfYMtM.t A--"d BY OMA _ 'S!Z L�` • .! .Aw �+�S - <br /> Gaul 1r.waetkm By O.en - Pu.f ilw~ l BY I - Owe <br /> Oarw"4..b."00~ - <br /> ��........: Zft.a <br /> P - <br /> ACCOLIIfTING,OwIR .- - AIM <br /> PE CODER PE!INFO AMMBfT RLlYSTTID cseEClvleAaH RSC9VEII aY OATS Fl3SYST/agIV1eE RS'DLIEIIT?fur~ IwvDIC>F <br /> 350 zoo <br />