Laserfiche WebLink
41 <br /> APPLICATION FOR WELUPUMP PERM* <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> (Campktt iR T►IpDeALt) <br /> APPLICATION 19 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/Oft INSTALL THE WOFK DESCRIBED.THIS APPLICATION IB MADE IN COMPLIANCE WlTTII SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER B•1 11 5.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH OM6ION. <br /> Joe ADDREssloa APNr 14253 S . AIRPORT WAX R <br /> ctiMANT ECA , CA 95336 PARCEL SIZEJAPNI 198-03-04 <br /> OWNER'S NAME TIF ('RnnT �nnL� <br /> 0 ADORE B B Q(eft 'RURy V ('T R,��LIy�--PHONE,?09_4 71 —1 78 <br /> AOIx>F66Pn RC1X cit ucr7 7(l Q(1 4 PHONE <br /> CONTRACTOR V&W DT2TT T 'l l J 7 <br /> RIO VISTA, CA �' PHONE <br /> SUB CONTRACTOR <br /> C] MONITORING WELL IF <br /> TYPE Of YVELUPUMP: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ OTHEfl[I VAPOR EXTRACTION WELL f � <br /> [I INSTALLATION ❑ WELL SYSTEM REPAIR ElCRO88-CONNECT REPAIR FIRST WATER LEVEL D <br /> ❑New❑Ftepelr H.P. DEPTH PUMP SET----"' <br /> (TYPE OF PUMP/ ❑ GEOPHYSICAL WELL r ROIL BORING�t S <br /> ❑ OUT-0E-SERVK:E WELL <br /> ❑DEsraucTlow CLOSE BORING WITH NEAT CEMENT GRQ <br /> A <br /> INTENDED USE TYPE Of WELL CO NSTRl1C ilON tPEC1FICAT10Nt <br /> DIA.Of WELL EXCAVATION <br /> GIA.OF CONDUCTOR CASINO D <br /> ❑ INDUSTRIAL 11 OPEN BOTTOM DIA.OF WELL CASINO D <br /> ❑ DOMESTIC/PRIVATE ❑GRAVEL PACKI8I7E TYPE OF CASINGISTEELMVC SPECIFICATION R <br /> DEPTH OF GROUT SEAL <br /> E) PVHiJC/MUNICiPAI 1:1D(SVEN GROUT BRAND NAME E <br /> ❑ IRAIGATIONIAO ❑OTHER GROUT SEAL INSTALLED BY <br /> GROUT SEAL PUMPED: ❑Y« [1 Ne CONCRETE PEDfBTAI BY DRILLER:❑Y« ❑Ne S <br /> ❑ <br /> MONITORING GROUT <br /> LOCKING CHESTER BOX/STOVE PIPE <br /> APPROX.DEPTH CABLE nP oTHERS'EE <br /> PROPOSED cONSTRUCTIONMRILUNG METHOD: MUD ROTAR'I <br /> AIR ROTARY AUGER <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE IAlITH BAN,IO CERTIFY <br /> THAT <br /> IN HE PE ORDINANCES.STATE LAWS.AND FOR WHICH <br /> RULES ANO <br /> THIS PERFARSFS N JOA NOT COUNTY- <br /> HOME OBUBJECT TO WOREKMAN f COMD AGENT'S IPENSATIONGNATURE CLAWSIOF CALIFOFO-SAES T14F W.1'N FOLLOWING <br /> RTS WRING OR BUB-CONTRACTMIQ SIGNATURE CERTIFIES <br /> THE FOLLOWING:IS ISSUED.; 'F CERTIFY THAT IN TEMPHE PERFORMANCE OF THE WOR FOR WHICH THIS PEAMTT IS ISSUED,1 SHALL EMPLOY Pf ABONS SUBJECT TO WORIONAN'S COMPENSATION LAWS OF <br /> CAUfOFWFA.' THE APPLICANT MVtT Al FIGURA IN ADVANCE FOR ALL REGUMID INSPEC�}Nt�T 121"1408-3-423. COMPLETE DRAWING AT LOWER AREA PROVIDED. �I <br /> D <br /> � �- et• <br /> Tlth <br /> Stoned X 1 •. / �'�' <br /> PLOT PLAN IT)—to SO"'Saele 'to <br /> 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PRO I`O6E0 <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNOINO THE PROPERTY- EXPANSION OF SEWAGE D48POSAL SYSTEMS. <br /> 2. OUTLINE OF THE PROPERTY.GrAM DIMENSIONS AND NORTH DIRECTION. S. LOCATION OF WELLS WITHIN ILADWS OF ONE HUNDRED FIFr FT, <br /> J. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED ON THE PROPERTY OR ADJOINMG PROPERTY- <br /> STRUCTURES,INCWDINO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS' <br /> i <br /> . ... ............... .....:..................... <br /> DEPARTMENT USE ONLY <br /> Aimll.*O Aeemted By <br /> Oroul M..peetl—By <br /> Dete Pum?Irnpeetl—By Dote <br /> Dete <br /> O.r.truetbn I—pxtke By <br /> 7 r <br /> Comme N• <br /> ACCOUNTING ONLY: AID/ fACI <br /> PE CODES FEE two AMOUNT REMITTED CHECKIlCASH RECEIVED BY DATE PERMITISEAVICE REQUEST NUMBER INVOICE <br /> ItZ <br />