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Z)Z) L11 K g - APPLICATION FOR WEL iJPUMP PERMIT SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 46&3420 00II-REFUNDANIE PENMIT EXPJIES 1 YEAR FROM DATE ISSUED (campl/t{ IK 711PIM{I{I APPLICATION IB HFRE BY MADE 10 THE BAN "AwN COUNTY FOR A PV}..N TO CONSTRUCT ANDIVR INSTALL THE WOR( DESCRIBED, TINS A"'UCATION M MADE SI COMFMANCE WITH BAN JOAOUtN COUNTY GVAt.OPIAENT TITLE. CHAPTER 9.1115.3 AND 711E STANDARDS OF /AFI JOAOVIN COUNFY PUBLIC HEALTH SERVICES. FHVDk1NMENTAL HEALTH OtmMON, JOB ADDIKE@S/OR APNS PZ5 - 140. OLI 24917 E BIZ" RT CNY _ LOP I PARCEL SITVAPNI 315, ZYA mAma-{ NAME GA3T M-1 fluNif_ 'PAL Iy21LIM D16T¢ICr ADowe{{ te. Dwc 7.4pas Acsws esr-L-4 D 791 3 muFm #- 7U CONTRACTaREIJ 'DJLIu_10s. G0"eab (I IA C'. ADOMMIR P.O. 509 51Ibz Pd4trAl,.TD Ucr l Wi48? mfoNEi_S,SU-32Z-2$§7 I e11B cRNTRA.c7oN �( AOf)EeE 11C/ NtONE / _ _ TYPE or WELIIPUM_P,, U/ NFW Wfu ❑ REnACEMENT WEIt L•1 MONHORNM/ W[LL /Zit E2(1nE:'jfi�5 ❑ aTNELL,� �- ❑ OMM-LATION ❑ WFLL SYSTEM REPAIR ❑ CROBS-CONMCT REPAIR Cl VAPOR f%TRACTON WELL DYPE OF MIMPL ❑ N.w❑ m.* ".p. _ DEPTH PUMP BET _ rT. FT WATER LEVEL F -L F� P-� IRS Q OUT-OF.BERVIC2 WELL U OEOAIY{ICAL WTLL f 0 SOIL Bf1RNO {�-+ ODEBrRFCT1aN,UPDnf tar��ET/aN y�CAIN&&EWLnON OF SVP"HEpl-ATAl- Wriex SUPPLY PKOJE.G.T (j-'2e06i o,6gavu -IL'pe�hmn IJI ._� cell{ ION IFICAT i A 1 " ❑ OIWSinAt ❑OPEN OpT70M DIA. OF WELL EACAVATION_ llfl DIA, OF CONOO VCTOR CASINO ❑ OOME{TK:IR.VATE 1�10MVEI PACK/BRE TYPE OF CASMKIIBTEEIM�C PVG 01A.OFWELLCASINO ❑ PIFIRICRAURCIPAL ,11 U DRVEN DEPTN OF ORpUr SEAL l; Or rl1Y E)E� SITCFICATION R ❑IRRIOATIM(AG ®OTHER PIE'tonVMr_ OROWI)EALDISIALLEDI.DB�Y DgILLEER. GROAT BRAID NAME LE;mewCR4UT E ®NR MOORING WA-MIZ LEVEL- OROUT DEAL PUMPED: {)Yn ❑F4 CONCRETE PEDESTAL BY DRILL R! ❑ Y. W<. S A"%OR. D -TN 40 FST LOCILSh7 CHESTER IgkFSTOVE PRE L.00LKR4f6 CPP a " C PMOro{m COTN711UCTIONA71@lUNO METHOD: MUD POTAIIV AIR ROTARY AUGER V CAALE OtHfR _l�.*4l` 1 NEVOY "REIFY THAT I HAVE PREPARED TNL@ APPEDCATION AND THAT THE WORK WILL BE LIONS IN ACCORDANCE WTrN BAN JOA OKRN COUNTY ORDINANCES, RATE LAW{. APO RULE{ MID PEOI/LAT)" OF THE RAN JDAOUM COUNTY. FWMP OWNER an tDCENSED AOENT'D {ZONA TORE CERTIFIED THE rOLLOWNO' •1 CERTIFY THAT IN TIM PERFORMANCE OF THE VFO FW I'MYVW1/ 1180 /Erm IS tBDUED. I SHALL NOT EMPLOY PETMDNB MMXCT TO WORKMAN'{ COMF{IEBATION LAWS OF CALKORMNT A.• CONTRACTOR'S RBRNe OR {UBCONTMACTMe ■KINATURE CERTIFIED TIIf FOLLOWIFM! • I CERTIFY THAT M THE PERFORMANCE OF THF WORK FOR WHICH THIS PEOMIT It IDSUELI. 1 4"ALL EM"Y RR6OH{ %UlQtCT TO WOIIONAN'{ COM-MIATION LAW{ OF CAL1F'URRA.' THE A"/CART MU@T CALL 74 FIMDI{ DT AIDVANCII FOR ALL ILEOIARM 049M "ll AT ISML 4M-34". COW -LM VRAWM AT LOWED AREA PIbVOED. P. -d �T�Xean a1, Ylo�s� _Tin. A525kfia» f G'yrl 'nctr n.K. ✓ung �ji998r ne r MJLN e>..w 4 e<.+., sa.i. Stt dr�yt•M�.� 1. NAMES OF STIRMS OR ROADS NEAREST 70 OR @OUWVM THE PHOPERt Y, lS 4. LOCATION OF HOVE SEWAGE 04"OAL {Y{TEM eR PROPO{EO 7. dnLNf OF TNF PROPERTY. OTYNG OrME 1111014@ AND NORTH DI ECTION. EKFANOON OF SEWAGE DISPOEAI {YSTfMD. J. LSMPNBONEO O1/TtPWG AHD LOCATION OF ALL fllWr*M AMD PnOTAHEII S. LOCATION OF WELL@ WITS N RADMB OF ONE HUNLIIED FIFTY FT, STRUCTURE{. W010INO COVETED MEA& {UCII AB PATO% ORVl1NAY{. ANO WADJKS. ON THE PROPERTY OR A0J00AN0 MIOPER'TY. PE COOED S" Rf URa AMaKNT RTMITltn CHECKAICAISH -- 00 -w M77- mctTVEU{Y DATE FETWBTIORMCE REaIIE{T MUM/DI RNOICE J