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SAN JOAIIU€11 COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH onnsiUK ` I <br /> 804 EAST WEBER AVENUE: STOCMN. CA, X88 y <br /> • (203) 488-342a <br /> NOIi-REFUMPABLE PENUMA <br /> JCATION IS HERE Sy MADE TO THE SAH JOAOUIN COUNTY FOR A PERW tr TD CO ' <br /> +t"UtN COUNTY DEVELQPWLETTTTLTI-.CHAPTER 9-1116.3 AND THE/�AHI},RRDS OF SAN JOA OUNTY PUBLIC HEALTH 99MCES ENVMNMENTAL H JLT14 S APPLICATION is MADE tpt.�ltgtpRJMtCE WITH SAN <br /> rop 4 SMPL AM# 125 O S Q.s�rli_t r� /y-L/L�L tn.0 cfry A.t1. � <br /> hl a 7'tt NAME L�J�//� `` ���.S12FIAPNI Za0�1'so'ts�y� <br /> AanRbgsfi D .J�• a PHONE I-7►�'c <br /> Cn G LS^ i c a..ti ` ADwEst;`316 / Q! Wa Lx:>r yYG <br /> f� <br /> �vx V I�arilrltiv r t AVCM,f $9Q 1e!`r rl a.ce, <br /> LIc, X865 PHa ���ii 7� -..3SO <br /> 3 <br /> =7, <br /> z <br /> a"ttmAmm ❑ mwvmL © REPLACEWrcNr WELL © IMOMI mom WRL• <br /> © SWAUATHM W=sY M M R FAM [� CrOf�CC3 VAPOR --•-- <br /> Df�NNICT11ePAIR 13 VAPOR MXTIIACTifON vAELL <br /> ❑Nrw D K H A DEPTH PUrAPiET FT. FIRIiT WATER LEVEL~r!r 4 — ✓ <br /> YPE O� F Pmt! <br /> t ❑ <br /> OUT•OP-RRy10E wal `�y' O <br /> 1 DESTRL7CTION ❑ Qom•��I fatL <br /> I&NI)IR us co- <br /> ATION <br /> MWSTMAL ❑OPEN ROTTw 11 A <br /> DIA.OF WELL EXCAVATION bIA.OF COF1QUCTCR CASINO <br /> ' DOMeaT•IC/FIwATt: ❑oRAVEz,Acx,IlaE a <br /> ���� . TYPE OF CA88JOHSTEE7^q DIA.OF WELL CASINO <br /> P3�`.DL1C:IMLITiK:1FAL ❑0mvm p <br /> DEVTN OF OFiDUT 8E14. <br /> IMMOATION/AO ❑amm OROLM ITEM_INSTAL r w+►By fPECIFICATrON R <br /> MKWmOMM OROUr BRAND HAM E <br /> OROL11'SEAL PCKRNG ❑To ❑M CONCRETE PEDESTAL BY DRILLER.❑Y. ❑N. S <br /> LDCRINO CHEATEIR faJUlTOVtr�_ <br /> *Posm ComSTmX-nCN1DrtLt7NO MCFMW YUD ROTARYS <br /> A1R ROTARY- W ALNtEA_��'CABLEOTHER <br /> qk77Y CEITTIFY THAT I HAVE A71ED THtf APPL1CA110N ANO THAT THE WORM WILL,BE DOBE IN At:C <br /> 1'18 OF THE SAN oAam COt/PRY NOYE OWNER OR LICENBW AGVWM CFONATURE OMANCE WITH SMI JOAt;VIFf COUNTY O�fNAHCEfi.sTATE UWS AND RULES AND <br /> FT IB ISSUED,I SHALL NOT EMPLOY PEItmwe fVILJECT TO wOlatlYtAN•i C CFlCftc TIIE FOLLIT%VM 7 CERTTPY THAT SN T$M PEI'POR7dANCE OF THE WOWC FSR WHICH <br /> -I CaTmpY THAT TN THE C3q TM <br /> LAWS OF CAL�PORItIIL- CaI'1TRA oFi-s HTWNO ON gUb CO?ITRADTINO sIONATUItE CeRTTFCES <br /> .fiL.)RMA.• ANCd OF THE WOIK FOR WHtCR THIS PVUM r Tg ISSUM.I SHAH.2UPLOY PERSBNf sU6JECr TO MIOl1RXIAN•i CWIPEN A TION LAWS OF <br /> wFPtJFAIYr C HOLMN IN ADVANCE FOR ALL REOCW=INsiTICMMS AT tM 4M442t. COI.i <br /> I[ETE ORAVVINO AT LOVMR AREA PROVIM y <br /> :rf X ir+ Tltl. Gvt,,� � �� 1-242J, <br /> >pt. �ZG <br /> W t �r <br /> PLOT AN xmr tr garM1 tle.i. -to <br /> Ef b fTREETf OR ROADf ITT TO OR EOUNOINO TNF PROPUtry < LOCATION OF HOUSE gt1hIA0E DI9PO8AL RYBTEWI OR PriOPOfED <br /> IUTLM OF THE PROPERTY, DITuICNBIONS ANO NORTH DMCTTOH <br /> AIMENSONM OLrrUW._S ASV LOCATION OF ALL EXISTING AND PROPOem EXPANSION OF S MAOH MW40ML reftE'Mg <br /> %TRUCTLIREg,>NCLUOINO COVERW AREASSUGH Af PATIOs DMVEWAYB AND WALKS. C LOCATION O"VELIS VVFrHM RADFUR OF ONE HUNDI'M FIFTY FT <br /> ON THE I4gPERrY OR ADJOINING FMpEHTY <br /> s N V .e .. � „ — - „ -- - Y _.�.�.• __�_n�. 4.•_..-.-...mow...'-r.--+ - i . .-...�.. _ , _ _�� - <br /> �`� Seip 0 BACK .tut a11997- <br /> V1 RO�1h�20 A�-1-���tTi <br /> �� <br /> PERMIT I SF-RIAGES <br /> aEFARflureNT UtE ONLI' / `� <br /> a+orllrn Aee.o:.e!3Y �—/ / <br /> M trwa.a110.1 6T Dat. �g <br /> ' A/Y <br /> '--��hNp In.r.ali.n by <br /> wauatirn Itrp.aq.n By <br /> NG ONLY AIDE <br /> PACs <br /> PE CDDFA Fm TWO AMOLNT4tEhgTTED cHeelvA:ASH <br /> 350 Rl4CI3V1a EY aATt< <br /> . F'PlIAM'rIf9MCE RE'6UEET Nuhmm IMMICE <br /> i <br /> ?--3� #•Ot 3 2�0 <br />