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A <br /> ' SAA JOAQUI9 COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DI'MIOY <br /> P.Q BOX 368.304 EAST WESM AVENUE,STOCKTON. CA 95201388 <br /> MM 448-Mg : <br /> NOWREFUNDABLE P19tWT E7 MES 1 YEAR FROM DATE ISSUED <br /> OP PUCAT70N RS HERE 8Y MADE TO THIE SAN JOALIIAN COUNTY FOR A PERMIT TO CONSTRICT AND"1NBTALL THE WDW DESCAJUED.TMS APPLICATION 18 MADE IN COMFUANCE WRH BAN <br /> 10ACION COUNTY DEVELOPMENT TIllL,CHAPTER 9-1115-3 AND THE STAMAADS OF SAN JOAUMAN COUNTY mux FEALTH SlgRVICEB,EIIVIROIWENTAL HEALTH DIVISIOPI. <br /> roe ADDRESUMn APHr-" i CK�� X f1 k �sile CITY 12tYN tJ FARM BIZVAPHr '"1 L lkNa?FrS <br /> '"M-0 NAMIS �;Qy'tUMFV--_A1-1 � A FiN.�IOwT1�A��11[11.1�1TMpMM_;�1_Acowsa���1 G�.�/LPc�j��f.�� �.fk . ��.F 7„pem"t 0 415-r <br /> :GNTP.^CTOR C.,F-1L}�cU�iY.` ADOREBL CN`�7D OLS TI.KI".GF�1 lX'! �} CSO PHO �I.�IIS-Jlit�l��-I�I <br /> M CONTRACTOR l 1 &i-, -AL14C, PHoHE r of j Ljt- Ts <br /> YPE OF VVEIL JfAF'. ❑ ww WELL ❑REPIACEMIHT Wel Q JdONITORING WELL � 3 L � ❑oTNER <br /> [3NWALLAMN ElWELL SYarEM REPNR ClCROSS-COf1IECT REPAIR Mf 1��- C3 vAFOR ExrnACT1oN WELL• <br /> ❑New❑P.r+ H.P. DEPTTi PUMP S£T FT. FRET WATER LEVEL O <br /> FYPE OF PUMP? -� <br /> ❑ CUT-OF- E E WELL ltJ OEOPffYQCAL NEu E ❑ BOIL WfOW ”• a <br /> 7 DEBTRUCTIOH: <br /> fTEfOED LIiE TYPE OF WEIl. 22NLTRUCT1O01 SPFCIFICATIOMS A <br /> J WOUSTRIAL ❑OPEN BOTTOM DIA_OF VVELL EXCAVATION %cyi DIA.OF CONIOUCTOR CASBIO 0 <br /> 7 OOMEST-W. NYATE 'M ORAVEL PAMOZE 7 ILL TYPE OF CAmmmTEE[.1PVC l -'SP LULI Q L{L�MA.OF VMLL CAM40 D <br /> 3 PUMJCA.IUNCFAL. ❑DRVEN �'( �;u;�l�nt D97H OF 91ROUT SEAL La'f ffi4C}FCATIOH R <br /> 43 tMaAMOWAB ❑OTHER V MWUT SEAL INSTALLW SSY -t'rfJ.�'h(.L, flfpVT BRAID NAME T-� f <br /> J MONITVmma ORDUT SEAL PUMPED: MY. O . CONC M�jTE PEDESTAL eY DRU :❑ O YM W S <br /> PPROX.DEPTH LOCKING CHESTER SOXNTOW PIPE T kJU)L S <br /> MOPOBa C0AW U 0TK) JD0KLMO METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> iEc9MY CERTIFY THAT I HAVE PIIEPARED THM APPLICATION AND THAT THE WORK WILL SE DOME IN ACCORDAMCE WRTH SAN JOAMAN COUNTY ORDIWWCE'II,STATE LAWS.ARS RILES AHO <br /> ETIIRATTONS OF THE SAN JOAOUIN COUNTY_ HOME OWNER OR LICENSED AGENT'S OWNATURE C RTIFEB THE PDLLDWIMO:'T CO MPY THAT M THE PERFORMANCE OF THE WOM MR WFIIpi <br /> d16 PEMJLT IB 34 SHALL NOT E?APtCY 961100110 SUBJECT TO WORXMAH'S COSAPWSATION LAWS OF CALWORNIA.' CONTRACTOR'S ERRING OR SUe{OHTRACnFM SI@HATtPW CERTIFIES <br /> iE FOlL01MN8: AT E OF THE WINK POR VVPOC14 THIS PEPPArT W 18MIM,I SHALL EMPLOY PEINOMS SUBJECT TO WOIIgNAN'B COSAPOMATIOH LAWS OF <br /> ALI RNIA.' FOR ALL REGUIPSD WAIPWTTOHS AT MM♦Si COUPLETSAWING AT LOWeR AREA PROVIDED. <br /> on.e x - T. A=uGrr �pnDR/A6�lL <br /> RAT PLAN Ww—t.Do"Saws. '1. <br /> NAMES OF STREM OR ROADS HEMWNT TO OR SOU11UNI0 THE PfDPWTY. 1_ LOCATION OF HOUSE BEWARE DWM"AL SYSTEM OR PROPOS® <br /> OUTLINE OP THE PROPMTY•OMM DIMENSIONS AND NORTH DNRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> DMWNNOMED OUTLPIES AND LOCATION OF ALL EJUBTVM AND PF0POSM S. LOCATION OF W L"WITHIN RAONB OF OfJE HUNDRED FIFTY FT_ <br /> STRUC'TUM8,INCLIMM COVERED AREAS SUCH AS PATIOS,0MVIEWAYS,ANO WALKS. ON THE PROP9RY OR ADJOtNWG PROPMY. <br /> ..........s.....:....................:.............. ..........:....__ ..._.......�._..a _.._... ........... _ _ .. _.. ... <br /> _ _ <br /> : <br /> : <br /> . '. <br /> OMPART EWT USE ONLY 7 <br /> wa I-po am er Do* PkmP Inlr..ehn®R' D1II. <br /> .ui. n Inq.otl.n 8T USN <br /> ACCOUIITRO ONLY: AJDS FACa <br /> PE COom FEEINFO AMOUNT JdlMBTTIED CHECS/ICASH R IECRViD MY DATE P9 MITfi4►V1m ItcauEST MGIVIBm IHVg10E <br /> 2�0 7uuJ 2 t� 7-10-76 SOD /3 <br /> � .d WO'Jd Id9?' L L S66L-0L-I <br />