Laserfiche WebLink
APPLICATION FOR 9VELLIPUNIP PERMIT r <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION 1i <br /> P 0 BOX 388,446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201.389 <br /> (209)488.3420 JLjN 1 1995 <br /> NON-REFUNDA911 PEANAT EAP1AEf I YEAR FROM DATE ISM ENV' <br /> IcS.Vi.IB IN Tr40pt.1 11YY--Tow <br /> A/{t KATgM MNEN BV WDE TO 7HE SAM JOAWIH COUNfY POR A PERMIT IOCONSTRUCT AHp/OR NSTALL THE YORK DEOCHIREO.1.11,APf'TrP�E�E16�pt]®I�=�L1E YATN 8AN <br /> JOAI:UN COUNTY DEVELOPMENT TITLE,CHAPTER 8-111 5.3 AND THE-ANDUDB OF BAN JOAWN COUNTY MABUL HEALTH SERVICED,ENNROHME ,y,I, SFT_ <br /> 300 ADGNEBBPGR APNr. 6 ,�. /l 7 6 J; ''f<T erry l PARCEL 9lZEJAYNN <br /> OVAVEft'S N,WE 6C�� 1.L ADDRESS <br /> coNTw.cTOR_' - i - P 'L, � ,�_r l( ADDacaa e <br /> .UP CGNTPUCTDH ADDIE88 UC! R70K 0 <br /> vmp� ❑NEW WELL ❑REPLACEMENT WELL ❑MONITORING WELL r T❑�OTHER <br /> L-. -Q--f118TALLA—N ❑WELL M 1UP <br /> 8Y8TFUN ClRg <br /> C88-CONNECT REPAIR ti.l VAPOR/ FR RACTIONNW/ELL r <br /> omN .' H.P, '1 DEPTH PUMP MT� VE <br /> ET. IMT WATER LTL/�)� O <br /> ❑OLEF OF-SERVICE WELL ❑OEOPH—AL WELL r Cl 801L BOPJNO a <br /> LJ DElTmu r.DN: <br /> it91 YPE N R CONSTRUCTION rPECWCATq Ne A <br /> LJ NDUSTHLLL 11O-EN BOTTOM CIA.OF WELL EXCAVATION OLA,OF CONDUCTOR CASINO 0 <br /> /DOMESTICR'FEVATE ❑GMVEL R'ACKIBIZE TYTE OF CASINGIS'TEELJPVC DIA.OF WELL CASINO O <br /> ❑--,cNiIu c.'A/. El DRIVEN DEPTH OF GROUT SEAL RPFCIFICATION ,T <br /> IQgAO ❑ <br /> IMATION/ OTHER GROUT MAL INSTALLED BY GROUT BRAND NAME E <br /> U MONTTONNO GROUT SEAL PUMPED:D Yr ❑No CONCPETF PEDESTAL 8Y DP/UFR;❑Yr ❑— S <br /> APPROX-DGPTH LOCKING CHESTER WXrITOVF APE_ S <br /> PROPOS CGfUFFW/CTIOlA hvLU G MSTHOD: MUD POTART AM AOTAHY AUGER CARLF OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE N ACCORDANCE WITH SAH JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND A.U.ANO <br /> REOIMTgNB OF THE UN JDAOUIN COURT/.HGArE OWNER OR LICENSED AGENT'S "CELT IFIES TREE EOU.OVAW:'I CERTIFY THAT IN THE PCAFONRANCE OF THE Vvom FOR—ICH— <br /> THIS PURNIFT IB IBBUFO,I SHALL NOT EMPIAY R4ABON8 SVAlEf-T TO WORPJAAM'S COINPBISATIOM UWB OF GAUFO:bJIA.' CONTMCTOH'S HIRNO OR B "ONTRACTINO SIONATURE CEPITIHE6_�— <br /> THE FOLLOWING: •I CERTIFY THAT N THE PERFORMANCE OF,'HF.YOORf FOR VAIICH THS PERMIT 18 INSUED,1 9>IALL EMPLOY PERSONS SUBJECT TO WOMOAAN'S COMPEr1811TION LAWS OF9 <br /> CALIFORNIA, T APRICAMi WT CALL 24 H OLSU M A MV E FOR ALL RAGIAA�W"GC/3i✓Q/1�5/Af 110814M-S.]1. COMPLETE DAAWWO AT LOWER ANA RDOVIDEO. '/yy _ <br /> BNrw.K ,S(,'�J ...{�_�./,C;'J _ Tm. /-- � —7 nR. CFS _� /��' VI <br /> C� <br /> PLOT PMN ID,.—b BOM.I 6u _ �J <br /> 1.HAAIES OF STREFT8 OR ROAD.WARIEST TO OR BOUNDING THE RIOPi RTY. ..LOCATION OF HOUSE SEWAGE DISPOSAL a STEM OR PROMO <br /> Z.O—UNE OF THE FRGR:RTY,MvWO DIMENSIONS AND NORTH DIRECTROY, EXPANSION OF SEWAGE DITAIOBAL SYSTEMS. <br /> s. —IONTO BIONTO OVTUHFS AND LOCATION OF ALL EXISTING ARD PROPOSED S. LOCATION OF W 11 NRTHIN RADIU.OF ONE HUNDRED FIFTY FT. <br /> BTRUCTUNS,RNCLUDIIAT COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,ANO WALKS. ON THE PROPERTY OR AOJOINING PROPERTY, <br /> PAYMEN I <br /> RECEIVED <br /> JINN 19 1995 <br /> I S,, ,MUU N COUNTY <br /> PIJ91LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEPARTMEIff USE ONLY <br /> ApFE..tbn AoaPl.d BT�_ ._� r.L <br /> Grout 7n.p..tA.n BY— D.I. Pune DtiPSIIkn Rh <br /> Drvw.an My..Ibn D'/ D.I. <br /> ACCOUMT,NO ONLY: upr FAC. <br /> IRS CODES PR UFO AMOUNT RMTTFD HFC ICATH RECEIVED NY OATS ►YEAITISSIP—E REOLr UT NUMBER RIVOKS <br /> 0 <br /> J <br />