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�� N�c,��°► APPLICATION FOR WELIMUINP PERMIT
<br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES
<br /> ENVIRONMENTAL HEALTH DIVISION ����r
<br /> P,O.BOX 368.904 EAST WVEBER AVENUE,STOCKm.CA 95201368
<br /> (209)484-3420
<br /> 111 NOM-REFUMRABLE PERMIT EXPIRES 1 YEAH ON DATE ISSUEO
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<br /> APFEICATI:IN 1S HERE SY MADE TO THE MAN JOAOURT COUNTY FOR A PfR T TO CONSTRUCT ANDPOR INSTALL THE VAOW DESCRIREO.TIME APPLICATION IM MADE IN COI,,FIANCE Wn 11 SAN
<br /> JOAQUIN CUIMTg,ZV�NT TITLE,THAMES R.I 1115.3 AND TIM STANDA a OF RAN JOAOUIN COUNTY MOM 14ALT11 RFNNCES.FNVIRONAEENTK HEALTH OMS,ON,
<br /> JOR AOOMETPSADR APNE C a r e y C t. Lot $3c" Stockton 1 •S
<br /> PARCEL WIEJAMII
<br /> OWNER'S NAME Bill Zech ADDRESS P,O, Box 87 AgI,E 1(209)465-56C
<br /> GOITI RAJ:TOR Dejesus Pump & [dell Drillingl AOOPKMS 2582 Sellers Av u— 542641GH,E1510 634-33
<br /> MV.LONf11AGTDR T
<br /> ADDILESS^_ LICE —Ow r
<br /> TrFE Of MLL"Wr 1110HINV WELL C1FCPLACFMFNT WELL ❑MOWORNO wEu.• 11 DINER
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<br /> f, 1T-0•L WITTAI-LAT10N ❑WELL SYSTEM REPAIR 0 CMSS•CONNMF REPAIR ❑VAPOR ERTRA_TION WELL I
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<br /> ,111 h- NI Cl FepAlr N.P, MPT"MMM SET_FT. RMT WATER LEVEL
<br /> fTYPE O■RuMP1
<br /> ❑OI/T�Of-SERVILE WELL U GFORIVSICAL WFLI S ❑ SOR RO:n"a q
<br /> ❑bESTRVMION-
<br /> INTIND[D USE TVP[OF CON S7 II..SILCIFECATION A
<br /> ElINOUITMAL 13 OPEN F.0"OM DIA.OF WELL EXCAVATION 12=IL `GIA.OF CONOVCTOR CANING 0 ^
<br /> ❑DOMESTMIPRIVATF ®GRAVEL PA—J.,ZF TYPO DF CARMIONTFTUPVI;_ ` `/ADF WEII CABRID D U\
<br /> ❑RISUCMUNICIPAL ❑DMVTN OEI'IH OF OIIOVT 9EK � /.fPECi1CATION q
<br /> 0 IRRIGATIONIAO ❑OTHER GROUT SFAL INSTALLED��B1Y Driller GROW BRAND NAME e m e n g r o u t E
<br /> ❑MOM DOSING `] gyp, OPDUT 6EK PVMIEO:N.I V. ❑1b LONG PETE PEOERK SY OPSLLER❑V. ❑Ne
<br /> ATISRD/.DTDTM 1j v &� IOCRINO CHESTER SOXMTOK PSE
<br /> PIFOP OSTO CONSTRUCTIDNIDISLUNO MFTNOD:MUD ROTARY— Y AIR ROTARY AFIOER CABLE, OTHER
<br /> 11IERESV CERi1FY THAT I IIA1,E PREPARED THIS AI,L'LICATION ANT,!FIAT THE.INOIT(1MLL RE MNF N ACCORDANCE VATH SAN JOAOUW COUNTY ORDINANCES,STATE LAWS, NO RULES AN
<br /> RFOVLATIONO OF THE RAN IOAOUIN COUNTY.HOME ONMFR OR UCENSED AGEHT'M SIONATURE C[RTURE THE WLI.OVVINOr•1 CERTIFY THAT IN TIIE PERFORMANCE OF THE VYOR(FOR WHICH III
<br /> THIS PfIR111'IS ISSUED,I BIIALL NOT EMR DY PFRSDNS SL/BJEcr TO WGRRMAN'S COMPFPNADON LAWS Or CAUMMSA.•CONTRACTOR'S HRUM OR M"ONTHACTNG SIOHATURE CERTIFIES
<br /> TIM FOLLOWING: •1 CERTIFY THAT IN"IE KWOIYAANCE OF THE WOR,FOR WHICH THIS PERMIT M 169VED.I THALL EMPLOY PERSONS SUBJECT TO WONO/R"COMIRSISA71ON UWB OF
<br /> CAlJFO • TIIE APPEIC T CA%74 NOESIS IN ADVANCE FOR ALL"E W IN.rKr ON.AT 1]WI 4Abif1,COMPLETE ORAVAM AT LOWER AREA 1'110 VI0(D,
<br /> wlv, X .IM. Owner ORI 8-9-96
<br /> FaGT raAN Id«.le e..w S..I. •ti
<br /> I.HAWS OF RTTFFTS OR RDAbS NEAREST TO OR SOUNDING THE PROPETRY, 4-LOCATION OF HOUSE NWAGE Die SAL SYSTEM OM PRDPOSEO
<br /> t.OUTLINE OF THE MOPFR .DIVING DIMENSIONS AND MOWN DRRCTION, EXPANSION OF SEWAGE DPOPTIM SYSTEM}.
<br /> 1.DONNSIONED INF
<br /> OVTLS AND LOCAIMN OF ALL EXIETMIG AND PROPOBEO S.LOCATION OF WELLS W ,RN MdUS OF ONE HUNDMD FIFTY FT.
<br /> alm':TUTrER.NCWDIHO COVETED AREAS SUCH AS PATIOS,T,RIVFWAYS,MST WALILS, ON THE PROPERTY OR AT,JDBEIND P/OIERTY.
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<br /> PE CODS FLE INTO AMOUNT REMIT CIIf !CASH RECBVEO Mr' DATE E81MIT1SFRVICF REQUEST NUNIDIR INVOICE
<br /> l O t ST 6 17
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<br /> PubHealth Sarv.-Enviro.173(3/BS)
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