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APPY--J ON FOR INELLIPUMP PERMIT SAN JOA! :OUNTY PUBLIC HEALTH SERVIL.,Q ENO-"MENTAL HEALTH DIVISION P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA%201388 (209)498-3420 II T-REFUNDABLE PERMIT EXPIRES I YEAR FRUM DATE ISSUED AFn ICA77ON IS HERE RY MADE TO THE SAN JOADUIN COUNTY rOA A PERMIT TO CW"IMP UICTIn TrWiomn INSTALL THE WpryL pFSCRIPED.THIS A JOAOVIN COUNTY DEVELOPMENT TITLE.CPIAI'rER 9.1 115.3 AND THE STANDARDS or SAN JOADUIN COUNTY PUBLIC HEALTH SERVICER,rNVTflONMFNTAL HEALTH DIVISION. u�A r"ICATION IS MADE IN COMPLIANCE WDH BAN JOB ADDRESS!..AMI__M qa _LI IoYE �.WOTfAI.o cltt 5� OWNEM1'R NAME PARCEL RNElAPNI MuIL.P AMnMtsg P, a. 'ari Q . RRaFpel C41T7AAC70R PIONS!_Cll S� S 7- E W 1 AnnnEpR QW. P�4Rr Lo uc! U Z -�2jyy PVR CONM ICTOfl KRONE/ AnIHTEFF. 'Q 2 AA��.T � TYPE OF WELL pUMP• ❑NEW WELL Il nFPACEMEW WELLIp 5 YS MONHONINo WELL! AEILE- W-6 EI.TATA ❑-r INRTFPA-t�LATION ❑WELL CYST EM nFPAIR ❑CPORA-CONNECT REPAlnn -.�—�—�-- L-I N—l..T 14q.1r H,P, ❑VAPOR EXTRACTION WEELLTL! J ti—OP PTMPI DEMO PUMPSEE_-_F7, FIRST WATER LEVELN ❑ ry OUT-OF-CEAVICE WELL OFOP,YSIC,AL WE'L f ❑OE6TnVCTION� SOIL$OAING A INTEND ED use TYPE OF WELL CONETRVCIFON ipECIE1CA TIONS ' ❑INOUS71$AL ❑OPEN"OTTOM DIA.OF WElL FMC,AVA7ION ff �J J^ A ❑IEOMFSPICRTTVATE ®O nIA.OF CONOVCIOR CABIlIn //T- _�� n HOVEL PACK/SNE.�Z O TVI`E OF CAFINRIpiPf/PVC � L, ❑I' OUCMIVHICIPAL ❑b," L SIA-OF WELL CASIN.!! Z Ef n OETTRI Or GROW 6EAt- 115 C� BCECIFICATION Sf_I4 t nvll � S ❑I IRRIOATIONIAn ❑OTHER (-MUT SEAL INSTALLED NY L p UY MOMTOMNO p� -E-UT RANO NAME 79 P I0 �•,IE)ETF" E APPROX.brnN / .MUT HEAL PJMPFO'❑Y— Ne CONCRETE PEDESTAL BY DRILLER-IRyw JN, S _-�__ LOCKING CHESTER NCyy ROK/RTOVE PPE of P"oP17EEo CONSTNUCTI IRR)eLLINO METHOD;MUD MTAPTYAVGEfl s AIR ROTARY. �_�CAPLE DINER I NE9FRY CERTIFY MAY I HAVE PREPARED 7MB APFUCATION AND TIRAT TITS WORK WILL BE MNF IN ACCORDANCE WITIP SAN JOAOUIN COUNTY Of"NAHCES,REATE LAWS,AND AUIEN AND nEOULATN]N9 OF TIRE SAN JOAOVIN COV"Ty.HOME OWNER OR LICENCEO AIIENT'B 91GNATUAE CF MIFIE9 THE FOLLOWIHO;'I CERTIFY THAT IN THE PEWOnMANCE OF THE WORK Fon WMCIP 71119 PERMIT Ip ISSUED.1 SHALL NOT EMPLOY PERSONS SUBJECT TO WONKMAN'E COMPENSATION UWs OF CALIFOPMA.-CONTFLAcTOR'R HAEMO OR SU$CONTpACTINO BIGNATVnF CERTIHES TETE FOLLDWING: '1 CERTIFY THAT IN THE PERFORMANCE OF T17E WORK Fon WHICH TMR PERMS IR IpSUEn,I RIIALL EMT[OY PERSONS SUBJECT TO WOKKMAN'E COMPENSATION LAWS OF CALNORM_A.a- THE APPLICANT MUST CALL]A MOMS iN ADVANCE FOR ALL REQUIRED INSPECTIONS AT I2RM1 1 S"AL490-M;!-COY ER ONS SV8 C LOWER ATEA N-@ COED. EE 1. NAMFS OF STITTFIB OR NOT PLAN IOPFr 1n"O"p I, •In ROADS NEAREST TO OA BOLD ROM" THE E710 PEATY, i, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM on IT Dr0rEU !.OIRLBIE OF 717E PNIOKRIY,OMNO bTMFNSIONR AND IIORTH bII7F.TION, 3,DIMFNFONED OUTLRMN AND LOCATION Or ALL FBTRTWG AND MOPpSEO EKPANRION OF BEWAOE bISPORAL SYe TEM9, STRUCTURES,BJCLUDINO COVERED AREAS SUCII AS PATIOR,DMVEWAYS,AND WALKS, S, LOCATION OF WELLS WFFHIN PADIUN OF ONE HVEinnEb PIT"EI, ON THE FPOPEArY DA ADJOINING PROPERTY, o All, P/or rA d�leE;avm d0 .Z 4S FILE CO �ti� 2, A, ! 4 �On1,4a11'n-) PlGr) wtlE ce 0 i n5-Ev�t4�i�n.n p AV5-T 199 DEPARTMENT USE ONLY APPMe•l1n�AevevSal RY � �/ �� 1 A•I• lY��i M.. I n, ImPrKrlen BY Dn• ru„n ImP.ellen NY D•a n,.,r,nllen Annirllon nY F�DT J F DIA! D.,• Eemr.nr,r.: fits tfao t ,5` o�E• Cay. ffs ALL.VNTlNO ONLY; ARI/ rAC! PE CODES FEFINro AMOUNT AEMI77ED CIOECKFMASN f RECEIVED BY DATE POIAITT1EE11NCE RMUEST NUMBER INVOICE Pub,Health Serv.-Enviro173(3196)