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APPLICATION FOR INELLIPUMP PERMIT <br /> I SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMEIITAL HEALTH DIVISION <br /> P 0 9OX 388 445 N SAN JOAOUTA ST,STOCRTON,CA 0201358 <br /> 0091 4613420 <br /> I LION REFUNDABLE iTR/EIT EXPIRE-31 YEKR FROM DAT UM <br /> (ONSTR r in WOR*BIa1 <br /> 4FnlCA11pN IF H{IIE 1Y 11AOS m!nE aAN tOA,OWN COtIHrY FORA PERMIT i0 CONSTRI1rT ANObR 7rIST/3L THE Vrol'K p/ftcrwSn TI414 A►Ft1CATKIH TS MAGE 1N COIApt1ANCE WITH dATI <br /> JOA0VIN COUNTY OE,01LOPME(I1R TITLE CHA►TER 0 1119 J AAO TmF STAMAMS OF BAN JOAOI+N COrPT FLMUC HEALTH iKIMCFS DAMONMETTTAL HEALTH DlvirvOw <br /> I M!AOOAFel.'OR►MI. fr"C-A ��rrL!-p fe --- crry_.a7!�sCkr IV^ FAR-21L Sr2EIM"W <br /> OvslTnellAlr/ r5 �Rrhhr__htrrn !'L1t1lLl ArynacS.� C P IIrON[.-7d y��(_L,1.,.. <br /> eoNTRACTOR� _ '1�_ --Aovnesa f 0 Be X�� it Yie rd �r 8 nroNl► ELA <br /> IK <br /> *UPCONTRACTdR LVn xl~( AooaEee _�;n,t C!c'1L'rQ uc. l/.1 —O-E O1'7 <br /> ' (W WLL kN*Wttk.�IAPnEv,-.4a[l 3aMm <br /> ❑INVTALWION 0 WELL WWI"PEPAIA I]Cf e-1,l COIR Erle PEPAIR Q vAlvK ExTwACTIQH Vvku, J <br /> I M N-0 P..r.h M P_ twrl"PUMP NfT____rT FMW WATER LEVEL O <br /> TTYFE Of ll1MP1 Q E3 MIT sFmn[s WDLL ❑OInR1VFlf'AL WTtI l 0 SOR eONNd • <br /> PfP,mlcrmN_&2SSul -Crouff. l,tY��(3`,!s"►i �� .rte ini/�t�Ecl� CP•>ytn7F �W <br /> R,TENOEO WF TY F'A N <br />' ❑INOVSTpAI ©cmm BOTTOM GIA Of V+ELL EXCAVATION --~ VIA OF CONOVCTOROAW%O_Z: .. O <br /> Q DOIlEeTICMftVATE O ORkvEL PACK/SISE �.�' TYPE OF CANI10rtnfu►ve ,IYS.._____ DIA OF WELL CAMiT/0 IV O <br /> T„I gll7MVMr1PAL 4 nfVVEN OFPIM nF GwwT EE At— SPECTFICATjOW <br /> ❑IRR1rAT10N1AO ❑OTNEA GROUT SEAL RleTALLEO eY I.7�V c"OUT aft"M HALM <br /> ®Mn,lm wo r aROIIT FFAL (3 ..PVOK9 YN? COHCRETE KDESTAL OV DIYLLFA 0 Yw ❑N. x <br />' AMwdX OdTH ��'F LOCr7Nd CNEdrtR BOX wT"trot f <br /> MOPOS[D CONSTRUGTIONfplEWNO METHOD MVD ROTARY AIS ROTARY AVWFR _CAW pT1R 11�— <br /> cCtu�e 6ra,t ani fYt�in,e tic w/,Oct ecQ_ccrrenTL—ret__�e .rccz v� �cenc t ca_ <br /> f IfE11ESY CEAT"THAT I HAVE IMPAWD THit APFLICATNAND THAT iME VVaAK WILL eIE Oof a IN ACCORD►NCE%WTN BAN JOAOWN GOVNTY o HAHCE9 STATE LAWS AND ftllllE AND <br />' AWS Of <br /> WOV6ATiONa OF TH; <br /> THIS PERMR IS 11WIVAN JOAOVIN COVNrT HOME oVVrtSK pR NCANEED AOFNT q cgMArV71C[I}R KIEe TMF rOLLCMNOf I CEFRIf„THAT 1N THE FEPFOFIMAtICE OF THE H6'OM FOR WHICH <br /> D I SHALL NOT EMPLOY"MOR$SUSJLCI TO RK <br /> WOMAN i COMPEMSRTION LAWI Or CALIFDP"A COMRACTOR f MNNd DR GViV-CONrRACT.0 RKWIITVKE 14fISAT10N LAWB Eq <br /> lift rOLtowino 1 CErrrwy THAT M IME FEHIORMANCE OF THE WCWK FOR WIOCH TMA P(RMR IB ISBVED I SMALL EMPLOY""ONO#MECT TO WORKMAN S COM <br /> CAtWORNIA.{../I� AT►t1CANT M iT CALL ea"Milks If1 AOvANCF FOR►LL REO"*ED INffSCTrnNe JAT 12001"*-%422 COMPLETE DRA%%lWa AT LOWER AREA( VIOrO <br /> a Ori x flr TIP._y , EYIIr <br />' (' net FILAR Irh.vr M•w.1 R.r _�_ <br /> T HAMEq OF dTRE[T0 OR RDAM NEAREPf TO OP lOV++Dk7s TME r1I0PERTY • LOCATION OF NDVS!d[NrABT OISIVSAL BIYRTLI OR FTrnFpriFO <br /> OVTUNe OF INC pMpeRTY GIMNO OIAIENMMS AND WORTH WdCTION 0PANm0141 Of OEWAGE DIFfOVAL SYPTErAi <br /> I OIMENVONEO OVTLIEKR AMO LOCATION OF Alt TJIISTV10 ANO PROPOSED 6 LOCATIOII O!WllLi VNTHIFS/1/1b1111i Of ONE HIRiGPIO rlm R <br /> dTPMTIMEt INCLUDINO COVERED AIV-A&SACH All►ATIOd,MVFWAYA ANO WAtXB ON TME MI ERTY OIL AEt'10NWN11!RO►ERiY <br /> ( J \ip \ <br /> t <br /> Yy �l ritE r.l Aw.tr.s.n <br /> � <br /> `1, , `♦1 C1TC FUFf I <br /> Sl1[ILMI [AL�eP„rJ <br /> �a 1}S7 F,.w P T`.a.lP�IumFIL. <br /> —rc yl H d+ ANO <br /> f, r � OS%+ti PS� OFv7 m rus! 310 -A Orr <br /> I I <br /> 7 I <br /> T tr.r +.r...L.wq anI <br /> ti f <br /> � t � •u.T .PNP ax IIFrJIiG Srur«Nn N+4llIy« <br /> 1� � w� •.' dhM e+1l,"N1•"e.loot�.� `_..-.."" <br /> /1 do-w.el�E.w+ee�I w <br /> unpar MENT VSE on, <br /> Avdharlan Aal.Pl.d er Dj1Q .—Lail <br /> n tiF Mpw V.n M ON.-���PLrftf f-o""Or er OMw <br /> Oml w 400 Iti.. $—nl ,{ D.N <br /> Co-- <br /> a <br /> lw+nr,fr I �f ��Y ,fi /L/V• �k3 _ <br /> ACCOVNTLNd dNLY- --— AKN �• - _J•.• -- fACJ T •4 �f <br /> R coon VER INFO RIIBOVRT NOWTTW C C SASH IIECaVlk BY OA1�IFritroArmspritca BFEOtIpT N"N0s1 MVOIcs <br />