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.F1 '.IC.1`104 FOR%fLLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P O BOX 988,304 EAST WEBER AVENUE,STOCKTON CA 95201388 <br /> (2891 469 3420 <br /> MON REFUNDABLE PTRWIT EXPIRE? I YEAR FRDRE GATT ISSUED <br /> IGmpiele IN Trblratef <br /> WAT.-1E-11E BY U—1.THE SAN JOAOUIN CO.—FOR A PERMIT TO CONUYRVCT ANDKIR INSTALL THE WORK DESCRIBED THIS APPLICATION 16 MADE IN COMRiANCE WITH BAN <br /> N COUNTY DEVELOPMENT TETLE CHAPTER B 1115 3 AND THE STANOARDS OF PAN JOAOU ,COUNTY PUBLIC HEA�78 SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> C.4. �l1 C, I1, ( r� I`III,I1.1 L.r ( //r( �. s'r.-� <br /> JOB ADDIIE5"A APN►( / ! CITY C 1 / PARCEL SIZEIAPNF <br /> OWNERS NAME f './ rJLi l� r1 • / 7 y aZ l I ADDRESi /r�)C 5(,(//1 1� / '4 II I LI.�1 PHONE 1!c/� <br /> CONTRACTOR , / � UC/+; ' �FEfOhNE <br /> stlB caNrRAcson r E- > I �f // n / " / c (/I E - <br /> / J ��EE''''TR ADDRESS i/ UC►� 1. PHONE / I/ <br /> TYPE OF WtLI./NMP•, ❑NEW WELL ❑REPLACEMENT WELL ru MONITONNO WELL I I ILMI f OTHER <br /> ❑I--1 INSTALLATION ❑WELL SYSTEM REPAIR C)CAOSS�ONNFCT REPAIR 6�'�1.Wry-S ❑VAPOR EXTRACTION WELL F J <br /> W Hwa❑Rp.h H P DEPTH PUMP S[7_FY MI�1L')C1 FIRST WATER LEKL O <br /> CEYPE OF PUMPI Moll <br /> W k I <br /> ����..��''^^ / ❑OUT-0F SERVICE WELL ❑GEOPHYSICAL WELL I ❑ BOR 40NN0 / <br /> DESTRUCTION r..r✓� // �^ { / .. I .f / / / J C l [ ✓ .1 <br /> / r <br /> INTENDED USE TTPL OF WELL CONSTRUCTION SPECIFICAT10116 f <br /> ❑INDUBTRIAL ❑OPEN mnom DIA OF WELL EXCAVATION I OIA OF CONDUCTOR CASINO O <br /> �T <br /> Q ppNESTICIPSVATE ❑GRAVEL PACKlBI=[ TYPE OF CASIN0/6TEEl/PVC � / �f/ DIA OF WELL CASINO O <br /> ❑PUBUC/MUNICMAL ©DNVEN DEPTN OF GROUT sfA 1 J i r SPECIFICATION R <br /> ❑IRRw ATIONIAG ❑OTHER /J OROLET REAL INSTALLED BY OROUT BRAND NAME E <br /> ❑MONTrONNo ~ ORovr SEAL PIMPED ❑Y. ❑N. CONCRETE PEDESTAL BY DRILLER❑Y- [IN. S <br /> AFTPIGX DE H ` LOCKING CHESTER BOXfiTOVE PPE S <br /> PROPOSED CDN2TRUCT1GNfDRIW413 MITNOV MUD WTARV AIR PIOTARY AUOER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL DE DONE IN ACCORDANCE WITH BAN JOAOUIN COUNTY OROINANCE6 STATE LAWS AND RULES AND <br /> REOULATIOHS OF THE SAN JOAOVIN COUNTY HOME OWNER OR LICENSED AOEW 0"NATURE CERTfFIES THE FOLLOWING I CERTIFY THAT IN THE i'ERFORMANCE OF THE WORK FOR WHICH <br /> THIS KRkUT a ISSUED{SHALL NOY EMPLOY PERSONS SUBJECT TO WORKMAN s COMPFFISRTIDx UYYB DF CALIFORNIA CONTRACTOR S HIRING OR BUB CONTRACTINO SNNATURE CERTIFIES <br /> THE FOLLOWING I CERTIFY THAT IN THE PERFORMANCE Of THE WORE FOR WHICH THIS PEFIMIT IB ISSUED f SHALL EMPLOY Pf Abo NS 9V&1FCT TO WORKMAN S COMPENSATION LAWS OF <br /> CALIFORMA THE APNICANT MUST CALL 24 H*WA IN ADVANCE FOR ALL REPUIRFD 1148MMM AT t2P104"J 22 COMPLETE bRAWIW AT LOWER AREA PROVIDED <br /> PLOT FLAN ID—1.S..I•I B.r• 1. <br /> 1 NAMES OF STREETRO <br /> S OR ROAOB NEAREST TO OR BOUNDING THE PPE9rY I 4 LOCATION OF HOUSE SEWADE DIBPOSAL SYSTEM OR PROPOSED <br /> 2 OUTLINE OF THE PROPERTY OIVINO INMENe001,16 AND NORTH DIRECTION EXPANSION OF SEWAGE DISPOSAL BYSTEMS <br /> O OIMENBIONED DLETUNTS AND LOCATION OF ALL EXISTING AND PRDPORED S LOCATION OF WELLS WETNIH RAINUt OE ONE HUNDRED FIFTY n <br /> BTRUCTVJP28 INCLVDINO COVERED AREAE SUCH AB PATIOS DRIVEWAYS AND WALKS ON THE PROPERTY OR ADJOINING PROPERTY <br /> / � I <br /> ,r <br /> r I <br /> I <br /> I <br /> i <br /> DE)ARTVEMT LAI P-LY <br /> / + G <br /> G M..Ps.bA Br I T D.I D I <br /> AI:roVrnNo oNLr t.. Amr .Acr k <br /> PI COPFA i[E INFO AMG VST RZT TED C,IEC SIK aPH RIC RUED■Y GATE PS RRTM6 Ct REOVEIT RWPEK IMVOlCF <br /> r <br /> I <br />