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P. 2 <br /> APPLICATION FOR WELIIPUMP PERlw e <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> RO. I3OX 388. 304 EAST WEBER AVENUE,STOCKTON. CA 95201.388 <br /> (209) 468-3420 <br /> KOIFREFUKDABIE PERMIT EXPIRED1 PENIA PROM DATE ISSUED <br /> (CAmplab IR TOpOutel <br /> APPLICATION 18 HERE BY MADE TO THE SAW JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTAL,THE WORK DESCRIBED_TWO APPMATION IB MADE M COMPUANCE WITH GA <br /> JOAQUIN COUNTY DEvRopMENT TRLP,CHAPTER 8-1116.3 AND THE STANDARDS OF GAN JOAQUIN COUNTY PUBLIC HEALTH b'ERVICES,L'NVIRONMENTAL HEALTH DMStON, <br /> JOB AD REGaORAPN, 802 N. Cluff CITY .L00i _PA54 w m", 049-080-5( <br /> OWNERNANNE •._ - —.1'._ .. - -�-3 �- - AOOREaA- - <br /> PHo E� <br /> cortrRucTOR Western Strata Exploration, IncA GG?'- . - $ox 1664 x,552198 PHONE - <br /> R <br /> GUS CONTRACTOR ADOREGR tXv -�9 Wj;,4 7 3-1 1 1 f <br /> TYPE OF WELLIPJMPt 13 NEW vAt1 ❑ REPLACEMENT WELL 23 MOWmmNO WELL I MW 1 ❑ OTHER -5 _ �1,�.ma <br /> ❑ INSTALLATION ❑ WELL gYSTEM REPNR ❑ C110GB-CONNECT REPAIR 13VAPOR EXTRACTION WELL F --3'�y_�->•v f <br /> (TYPE OF PUMP) <br /> 133Nw C3 P...P.. N.P. OEPT11 RUMP BET PT. FIRST WATER LEVEL <br /> Bon.eoaNG 1 -3 0 Feet E <br /> ElOVT-0�OERVICE WELL OEOM <br /> ❑ fVBICAI.WELL/ <br /> ❑DESTNVCTIDN: 1 -45 Feet <br /> INTENDED WE -TYPE-OF WRdI. rONSTRUCTMN 4POGPICATION! A <br /> D INDUSTRIAL 11OPEN BOTTOM VIA.OF WELL EXCAVATION 8 1 /4 I I OIA-OF CONDUCTOR CASINO N/A <br /> ❑ DOMESTICIMVATE EI GRAVFL PACKM4E2/12 S and^,pc OF CASINGRTTEEI/PVC 211 S C h 4 0 OIA.OP wELL CAGING 2 Inch <br /> Cl PUBLx/MUMCIPAL ❑OIbvFNf <br /> oevlH OF GRotTT SEAN 2 7 Feet SPECIFICATION <br /> F <br /> ❑IRROATION/AG ❑OTHER CROAT SEAL INSTALLED BY �Wes X GROvr BRAND NAME P n r t 1 -n d E <br /> ® MONRONNO 50 Feet GROUT SEAL PVMPFO:❑Yes Xyw. CONCRETE I'EDELTTAL BY DRILLER:❑Yr A,I#le S <br /> APPROX.DEPTH LOCKING CHEATER BOX/BTOVE PIPE ` <br /> PROPOAED C009TRIXTIONAMOLLING METHOD: MUD ROTARY ARI ROTA" AUGER X CABtF OTHER <br /> I HVWXY CERTIFY THAT I NAVE PREPAREO THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COVNTY ORDINANCES,STATE LAWS.AND RVLEG AN <br /> REGULATIONS OF THE BAN JOACMN COUNTY, HOME OWNER OR LCENGEO AGENT'S SIONATURE CERTIFIER T►IE FOLLOWING:'I CERTIFY THAT IN THE PEWORMANCE OF THE WORK FOR WHIG <br /> TWO PERIAR It ISSUED,I SHALL NOT EMPLOY PERSONA SUBJECT TO WORKMAN-6 COMPfNaATION LAWS OF CAUFORMA.- CONTRACTOR'S WFDIRO OR AUBCONTPLACTINO WONATVRE CERTIFIE <br /> THE FOLLOWING: 'I CERTIFY THAT THE PERFORMANCE OF THE WORK POR WHICH TWO PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORIONAN'a COMPWO&ATION LAWS C <br /> CALIFORNIA:�iHE Av MvaT� 7 Hp ADVANCE Rm ALL II10AARM LNtLPE1CT1ONN AT 120814404472, COMPLETE ORANRNO AT EAWER AREA PROVIDED. <br /> A+-wX �1 L• c Ct2' T,�, President Do" 3-25-97 <br /> ROT RAN IO.ew to Ae.{y 9eNe -to <br /> See ENGEO Work Plan Dated3/25/ <br /> I- NAMES OF STREFTB OR ROADS P@EAFKST TO OR BOUNCING THE PROPERTY, 4. LOCATION OF ROUGE SEWAGE OIapCBAL SYSTEM OR PROPOSED 9� <br /> 2. OLITUNE OF THE PRVI <br /> OPERTY,DING OIMMSIONA AND NORTH DIRECTION. EXPANSION OF SEWAGE dGPOGAI SYSTEMA. <br /> a- 01MENSIONEO OtITUNFe Aa0 LOCATION Oi ALL lXISTMPROPOSED <br /> ANO OSEO S. LOCATION of wMe WITHIN RADIUS OF ONE WHORED FIFTY Fr. <br /> STRUCTURES.INCLUDING COVERED Aff,^8 PJCH AS PATIOS,DRIVEWAYS.AND WALLS. ON THE PROPERTY OR ADJOOANp PPDPERTY. <br /> r <br /> ...... ...... .. ... .,. ... <br /> DPARTMINT USE ONLY <br /> APVIIC.I1pn Aooepled <br /> By <br /> G—A I.s9-1—GTtruoatetln eT <br /> Dal. <br /> Ortrue-bt1 IvPeollen By <br /> Dote <br /> CoTttterta: <br /> j <br /> ACCOUNTING ONLY- NDI FACS <br /> I <br /> 4 FR coo" PITINFO AMOUNT RUATTED CHECKI/CABN RECEVED 8T DATE ROOUEsT"WEEK INVOICE <br /> J3 <br /> 'aq vl ` � C �� 2!1=3 ±27 '77 o <br /> f <br />