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APPLICATION FOR WELLrPUMP PERMf' � � <br /> } SAN JOAOUIN COUNTY PUBLIC HEALTH SES,_.L ES �,./ <br /> ENVIRONMENTAL HEALTH DIVISION' <br /> P,O,BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA Semi- 88 <br /> (209)408.3420 1I <br /> IIBK•REFUNDABLE_ PERMIT"PIKES 1 YEAR FROM BATE ISSUEDI > > <br /> z (Wmp6t/M Trwkw.) i� <br /> APPLICATION Is HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANUJDR INSTALL THE WORK OE86FAEO.THIS <br /> JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9.1115.3 AND THE STANOARDS OF BAN JOAQUIN COUNTY PUBLICHEALTH SERVICES,ENVIRONMEMAL APPLICATION IB MAGE IN CpM LICE WRH BAN <br /> HEALTH DIVISION, <br /> JOBADDAES&WRAPN/ Victory Park, 1201 Pershing Avenue CITY Stockton - 135-150-01 <br /> PARCEL MZFJAPNI <br /> OWNEWOUAME—City of Stockton ADDRESS 425 E1 Dorado Street PHONE 937-8829 <br /> CONTRACTOR The Twinina Laboratories, Inc. ADDFFBBPO Box 1472E Fresnb ut:/C57-5061591{DNE/268-7021 <br />{ SUBCONTRACTOR ADDRESS Ca, 93716LICP PHONE/ <br /> 7�'PE OF 1N 4 RL�IMF 13 NEW WELL ❑REPLACEMENT WELL JmMONrropuNo WELL/ MW-11 <br /> 13 OTHER <br /> t4 ❑INSTALLATION Q WELL SYStEM REPAIR ❑CROSSCONNECT REPAIR ❑VAPOR E%TRACTION WELL/ <br /> ❑N.w❑Ryd, H.P. DEPTH PUMP$E7 H I <br /> rrYPE OF FVMP ,..—.FT. i}FIRST WATER LEVEL O <br /> i <br /> ❑pLrroasER+ncE wcu Q GrpPGrstcu WELL/ Q wa BORING g <br /> 33OESTRUCTWN: <br /> IN E7T� DED ME TYPE OF WELL CONSTRUC O IF1C IONS A <br /> Q INDUBrfm El OPEN BOTTOM INA.OF WELL EXCAVATION 8.5[[ IOTA.OF CONDUCTOR CASINO N/A D <br /> ❑DOMESTICRRVATE P GRAVEL PACKMIZE 2 12 TYPE OF CASINOKTEEL/PVCPVC SCh 40 i OK,OF WELL CASINO 2T` <br /> ❑PUBLKIMUNIOIPAL Q DRIVEN DEPTH OF OROUt SEAL 12.5 f D <br /> t I} BPE[IFKATION R <br /> 13 IRRIOATPONIAG ❑OTHER GROUT SEAL INSTALLED BY Gr�7avit� f.'LIZ GROAT BRAND NAME E <br /> MONnORN4Q GROUT SEALPUMPED:Ely" f3w. I CONCRETEPEDESTALBYMULLIA QYM ❑Ne 8 I <br /> APPROX.DEPTH LOCKING CHESTER SOXISTOVE PPELluaL-js�eel cover g _ <br /> I PROPOSED CONSTRUCTIONIptlLUNO METHOD; MUD ROTARY AIR ROTARY AUGER XX 1 CABIE OTHEq _ <br /> I I HERESY CERTIFY TI/AT 1 NAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BATT JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND <br /> C' REGULATIONS OF THE BMT JOAQUIN COUNTY. HOME OWNER OR LICENSED AOENT'O SIGNATURE CERTIFIES THE FOLLOWING:Y CMIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH <br /> 1 THUS PEIIMfT IS ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CAUFORMA,�CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: •1 CERTIFY THAT IN THE PERFORMANCE OF THE V40RI FOR WHICH THIS PERMIT`IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPETTSATION LAWN OF <br /> CAUFONNRA.' Tf PIl AN !LL <br /> T RUNT CALL 24 HOURS IN ADVANCE I"ALL REFA WARINSPECTIONS AT"I 464,3423:COMPLETE ORAWING AT LOWER AREA PROVIDED. <br /> TIF. Project Geologist 11 Da. 6/10/96 <br /> PLOT PLAN IDr—t.S.d.Y Sed. •I. ,� f <br /> 1. NAMES OF ETRE R b s NEAREST TO OR BOUNORG THE PROPERTY. 4.11�LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED ' <br /> 2.OUTLINE of THE PUO GIVING DIMENSIONS AND NORTH DDIFCTtON. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> 1,DIMENSIONED OtrrUNF.O AND LOCATION OF ALL EXISTING AND PROPOSED a.LocATOO"OF wEtLO WITHIN Rmus or <br /> STRUCTURES INCLUDING COVERED AREAS SUCH AB PAIWO,DRIVEWAYS,AND WALXO, HUNDRED PS7Y FT. <br /> E' <br /> ON <br /> THE PROPERTY OR ADJOINING PRDPEFTTYE� <br /> E. Please:see attached-.sheets: Drawings .2.and=4. <br /> .,_. . <br />{ SP1 <br /> VPC ,... <br /> 121 . .,.. :....: .. <br /> ST( ' <br /> INENNE <br /> DEPARTMENT USE ONLY I'r �y'!f 7 ' <br /> F ApW{..rl.n Acwp[.d By tt ! 12,,1(— 3 <br />{ IJ <br /> Gram I-i—d n Br - 0.4 P—P M.p..O.n BY i <br /> h Ort—tlen IMp..tl.n By P <br /> D.t. <br /> C.mm .: D y/s�C 't l l CPxvyl c,�J i- I�oyti►-I cw 93 <br /> ACCOUNTING ONLY: AIO/ <br /> I <br /> PE CODEN FEE INFO AMOUNT REMITTED CHECK//CABN RECEIVED IV DATE ]PERMGTISEAWRCE REQUEST NUMBER INVOICE <br /> 5�2 �� 7-12-2k <br /> I I's <br /> i i�. <br />