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Aro" ,TION FOR INELLIPUMP PERMIT <br /> SAN.,j,3.1h COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P O BOX SK 304 EAST WEBER AVENUE STOCKTON CA 95201388 <br /> (2091 4613420 <br /> NON REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> IGamPYBEI in TrIphutel <br /> ICATgN RA HERS SY MADE TO THE SAN Jp AUIRN r.—FOR A pERLJp 70 CONSTRUCT AND/OR INSTALL THE WOMC O(SCRSED THIS APPLICATION IN MADE IN COMPLIANCE WITH SAN <br /> AOLRN COUNTY OF"I OFMFN`TTELE CNA"ER B 1 1 1 5 3 AND THE STMDAROS OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> // r/ / ; <br /> J06 ADORESSTR AfLJ1 r /J r CRY `�-�!/ ►HCFC SIZE/APH! <br /> OWNER■NAM / ! ~_ ! r r1 / !ri ADDRESS Ile'I1,(/ f 1- ; /1 / f PHONE A'7 1,b r. <br /> ADDRESS/"-V/! / r f r�LL UCf_1 _t_ ]I PHONE Fir <br /> 6V6 CONTMCTrIA AOOIIEa6 r/ / /L LICr r r r RHONE JA I <br /> TYPE of WEUjrr TJ Iiw w, ^ten y <br /> _ P❑��ry 11EMCEMEM WELL 7VJ-MOiMTORHO YKLL/ �� V!�^ ❑OTHER <br /> +I CI LJ WELL SYSTEM REPAIR ❑CMSSrONNECT REPAIR' �• VAPOR EXTRACTIDH WELL F J <br /> N.w Q A.r I,P DEPTH PUMP SET ►T f.W-� FIRST WATER LEVEL O <br /> n YPE OF RJUPy P-� �l <br /> OUT-0F SERVICE WELL. Q GEDRIYSICAL WELL S rw I, S ❑ SOIL BONNO <br /> ��u RLJcn TION ! ii�!< � /�'Jf � E f � - i .r/ � //r�f r 1 / // r.L S r i ✓ �i <br /> 1I-N�TENDED USE ...� 1 Y,r U.h CONSTRMtION SPECIFICATION■ A <br /> LJ INDUSTRIAL L)OPEN aC ROM DLA OF WELL EXCAVATION _ _ L_ DIA OF CONOVCTOR CASINO D <br /> ❑- DOMTRnC MVAY unAw PACISIeef TYPE OF CABINOPSTEEIIPVC r/ { OLA OF WELL CASINO D <br /> El "LICWUNICIPII OnnMITI DEPTH OF GRDUT SEAL 1'1 / STSCIFTCATION R <br /> R❑ WSGAMNIAC LJ C."o I GADUr SEAL INSTALLED By <br /> GROUT BRAND NAME Ivry f <br /> LJ MONRORING , w OROVr SEAL PJMPEO ❑Y. Q N. CONCRJETE PEDESTAL RY DSYLUPL❑Yr ❑N. S <br /> APPROX DEPTH _ LOCKING CHESTER SOX/STOVE PIP£ 8 <br /> PROPOSlDCONSTRUCnONNORSLVNi NlLrNO' MUDROTARY MR ROTARY AUGER CABLE OTHER <br /> L HF-*SV CFRTIr I fl- I HAVE P EPARLC T. S APFL.CATION AND THAI THE WOOL(WILL BE DUNE W ACCORDANCE WITH BAN JOAGUIN COUNTY ORDINANCES STATE LAWS ANO RULES AND <br /> REOULATYJFNSe , J AOVi Olrl-TY NO+ 01-En OR LICENSED AGENT S SIGNATURE CERTIFIES THE FOLLOWING I CEOMIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHI'H <br /> TWS PERMTT IL iGGJ 1 I T,IAI L NO AJI . PI ncG L SUBJECT TO WORKMAN S COMPENSATION LAWS OF CALIFORNIA COWCTOR a MWNO OR SUS-CONTRACTJNG MONATIPPE CERTITIES <br /> THE FOLLOVAFIG f.Et Fr T.11 n T •RFCPWANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED 1 SHALL EMPLOY PEASONS SVWFCT TO WOR07AAN A COMPENSATON LAWS OF <br /> CALIWRN A THE A-IJCANT M HOURS 1N ADVANCE FOR ALL REGLRRED INSrSGTIONA AT L706I 440 424 COMPLETE DRAWING AT LOWER AREA PH0VIDED <br /> tv�w X T10. D.. <br /> PLOT MN 10—le S.MH B.M. Ra <br /> 1 HAWS OI erALI ID I H ROADS NEAREST O OR NOUN04NO TNT PILOPEFTTY LOCATION OF/LOUSE SEWAGF....AL SYSTEM OR PFAOPOSED <br /> 7 OUTLINE OF THE PROPERTY GIVING DIMENSIONS ANO NORTH DIRECTION � EXPANSION OF SEWAGE DISPOSAL SYSTEMS <br /> ] DIMTNSIONEp OUTLMFS AND LOCATION OF ALL EXISTING UID PROPOSED E LOCATNJN DF 1NELL6 WTTHRN RADIUS OF ONE HUNDRED FIFTY FT <br /> S'T.'CTURES INCLUON13 COVERED AREAS SUCH AS PATIOS DRIVEWAYS AND WALKS ON THE PAOPERrY OR ADJOrNINO PNOPEWY <br /> I <br /> I <br /> II'!' <br /> / DVAATWENT BE ONLY <br /> G w .+ a�eI DH PVI.F IrrP..[Nm sr D•,. <br /> ACCP VNT.NO ONLY y9e FACT <br /> Am K COOEJ FET INFO AMOUNT REMITTED CHECSVFCASN RrCOVLv FY OATS POw.ITrSTRVICE RIGUIEST NURSER INVOICE <br /> J <br />