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t 3-'17-1997 13=59AM FROMIP PLICATION FOR WEELI-IPUMP PERMIT rt�efl Kn�Z er_ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES r-tx�)0 ) MAY 11 1998 ENVIRONMENTAL HEALTH DIVISION l U _ 304 EAST WEBER AVENUE, STOCKTON, CA 95202 phUh z– gc) SAN JOAQUIN COUNTY (209)468x420 PUBLIC HEALTH SERVICES NON-REFUNOARLE Milli T EXPIRE& 1 YEAR FROM DATE ISSUED ENVIRONMENTAL HEALTH DIVISION (CoMp4t•is TTFplfoatN AP"UCATION 18 HERE SY MADE TO THE SAN JOAOUW COUNTY FOR A PEFUWST TO CONSTRUCT ANDJOA WISTAM THE WOW D£8CA1fl£D."Us APFtfCATION K MADE N COMOWNCE 111M,SAN JOAGUMI COUNTY DEVELOPFAVIT'TffM CNAJPM 9-1115.3 A'MU THE STANDMWB OF ILMI JDAWN COUNTY1 ft=X NIF/1LTN 8F7lvICEa,ENIMONMENCAI 11EAlTN DIVISION. 4PIV(77-o 2,p. JOB AOOAE88/OR APTu_343/ -J, A-t f D6 rf W0.l CRY S7tbck- 1-7 PARCEL WFJAPNe 7� It�ADOHE68 2�a 0.K `c: L"tri/I �:6 ��,,( Ifo l COACTORC.T\ C'1�1✓I�,e1r1 Kej SCIS Ks �n �awc r9 (O'12�Ubaa cs PYRONE II wo- MCI M'RP8g� cvo coxTRAcroR G LS4 q .f�v. . S L Y1 ADDRESS G 57 y b►.oNE r 3l" 3 j $� ucs (. 56:.'7° j TYPE OF AklypvMf: ❑ NEW WaL ❑ JIMLACOWENT WEUu "O"ITOWNa VVELf r ❑ OTNEA ❑ INSTATJ,ATION 13ELL WBYSTFAT REPAIR CA08SCONNECT REPAIR ❑ VAPOR EXTRACTION WELL 1 J ❑N-0P..1I N.P. DEVTFT F�JMAP SET TT_ MRST WATER LfVL2 ti �-' 0 (TYPE OF PUuvi ❑ OVT•OF-SCMlCE WELL ❑ OEOlst rr:KAL WTu_r______._ ❑ cots FCTCNO ❑DESTRUCTION-, INTENDED U6EYVE OF WEIL, CONSTRUCTIONIN •PECCATIONS A ElDU INSTRIAL ❑OPEN BOTTOM dA.OF WELL EXCAVATION J U VIA.OF CONDUCTOR CASING p ❑ 000ACUTIC/PR7VATE U 0I AVEL PACKfME Z TYPE Or CASIMO/BTEEi SC�k YO OL $0 MA.OF MIML CASINO Z n 14 , p ❑ PU8IIC4AVWCtPAl ❑Ow'xm DEPTH OF GROUT CFi11 '-/O 9MCIFICATION R ❑ IRRIGATION/AQ Cl OTHER GROUT CEAL SterALLEV BY I i-,?^I GROUT DRANO NAME g �LtowTOa1NG G010VT SEAL PV►MPEO: ❑Yr ON.. CONcwm PEDESTAL BY ORIELER:M., ❑No rT'vrx+X.DPTY �� LOCKING CHESTEA SOX/STOVE 14PE V P.20POSED CONSTIiUCTIONIDR(LUNG METHOD: YVO ROTARY AIR ROTARYy�U°°R� --CABLE OTHER 1 HE`Xt3Y CERI"IFY THAT 1 HAVE PTCEFArQEO Y*S APPLICATION AND THAT THE WO"K V -L at GONE T9I ACCOfCkANCE W+TK SAN JOAQUIN COVNTY OPOINANCF:9.CT AYE LAWS,ANO WLEH ANO REGULATIONS OF THE BAN JOAO'J'"COUNTY, NOME OWNER OR LCENSEO AGEITT'S OPGMAYURE CCATIFI€S THE fOUO%TN0:'t CERTIFY THAT M THE PEF"RWAANC(Of TffE WORK Mn WHtCN TMS PERMIT 18 TUBUED,f 911ALL NOT UAPCOY PERSONS IRA7JECT TO WOR3WAR'f CfWAft NSATIOR LAWS OF CAL1'OPMA.' CONTRACYOR'8 MRCNO OR RUB-CONTFACTtNO 81GNAYURf CERTfiTEB THE FOLLOWINC: '1 C[MtFY THAT IN TICE"OAMANCE OF THE WCMK POA WMtCH TMS P'EP041T IS 188UEU.I SHALL EMPLOY PERSON®StISJECT TO K'OR"AAN'S C0.46'TO./93ATION LAWS Of CAIJf ORNIA-' THE APRCAL/.24 IAUXT CA2A HOURS IN ADVANCE FORA"AR--GL4gfJ IMtPECT90Rs AT M*01"/-34Y4. COUPLETE VRAWINO AT LOVrtR AREA fNOOVtOEO_ C, 2"/•-�/L-G<.c-f 4 Thl. PLOT PIAN 101w 10 Sode1 Saw 'to 1. NAMES OF STREETS OR ROADS NEAM9T TO OR BOVNOINO THE Pf*MATY. A. LOCATION OF HOUSE SEWAGE OISPO8Ak SYSTEM an MIOPOGEO 2. OUTLINE OF THE PTIOPCATY,GNfNG OWENPONS ANO NORTH DInEcT1ON, EXPANSION OC GCWAOC DISPOSAL SYSTEMS. 3. D1MCNSAONED OVTUNFN AND LOCATION OF Ali£X141710 AND PTOROSED i. LOCATION OF WELLS V4rngN RADRIS OF ONE NVNORED FIFTY FT, RE STRUCTV8,B+CLUDING COYEMZO AAtAV SUCH AS PATIOS.bRVEWAYS,AND WALKS. ON THE PROFEMTY OR AOJOFW4 PROP4RTY. .. ...... .. I .... . .. t c' J` J ..;.... .., j .. .. 13.. .... ............a .... ..r.....'.... ..i-.....; .. t .. .. I ...7... ...4... ...... ... .. ...q.... .q.. j ............... .i .�.. .�... ..T... ...q... .. ....�... .1.....<•... .. ..h.. ...... <.. t ..j.. I t i .. 3. .... .w .. ..f........... . ... ... .. .. - .. .... : : OEFARTMSNT USE ONLY / Aovllo.tf n Aee+otad By (�W1�—l' V Y Date �� — /G kr 07 J-b Grout Iwc.t/bn Sr O.ts Rn.P 1rrPrdon Br O.t• D..I..a1lan I.�P4.otbn BY Ce.....vY.• O •Giyl.r•/f ir-s -K o A n ��.�i� r y ACCOUNTING ONLY: ATDr FACT PE CODES P[E TNFO AMOUNT ROMTTW CNECLICASK RECEIVED BY GATE FEIM IT)SERVICY REOLIEST NUMBER INVOICE