WORK PLANS - Laserfiche WebLink

Home Browse Search

k APPLICATION FOR WELLIPUMP PERMIT SAN JOAQUIN COUNTY PUBLI HEALTH SERVICES ENVIRONMENTAL HEA TH DIVISION 304 EAST WEBER AVENUE, S OCKTON, CA 95202 (209) 468-34 20 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER (CaRlplete M Tro etel APPLICATION IS HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/0 INSTALL THE V40W DESCRIBED.THIS APPLICATION 19 MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE.CHAPTER 9.1115.3,,AND THE STANDARDS OF BAH JOAQUIN COUNTY PUBLICHEALTHSERVICES,ENVIRONMENTAL HEALTH DIVISION �0_ JOB AOORESSIOR APNI 1 ` f CAjV4 S V ILl Gl I ``-- � [\` L C PARCEL B1;ElAPMI' OWNER'S NAME S)m// 7� �+W, ♦� S L�O, 0\-,,v f (,+ADDRESS 4 .1J 2 LO e l 1^ PHONE N CONTRACTOR d V tJC+► V\F - ADDRE89 [' LOAL- (LI W%4 1 4 Zy 7 1 ''��[[]]_7041 ` uPHONE R 5 ^J'L.Z'F fI RUB CONTRACTOR T'%�I\ ADDRESS PO ,� RLO�lS�b. UCS 171— l0 + PHONE• 7�0 _ 379-7-375 TYPE OF WELLO MP: © NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL• ❑ OTHER ❑ INSTALLATION ❑WELL SYSTEM REPAIR ❑ CRO89-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL/ RIPE OF PUMPI ©Naw❑Rapalt H.P, DEPTH RUMP SET FT. FIRST WATER LEVEL O ❑ OUT-0F-SERVICE WELL ❑ GEOPHYSICAL IWUL s *8011 BORING S ❑bESTRUCTION: INTENDED USIE TYPE OF WELL CONSTRUCTION SPECIFICATIONS G� A © INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION f..t� ON.OF CONDUCTOR CASINO /V 4 D ❑ OOMESTHCIPRIVATE ❑GRAVEL PACKISI;E TYPE OF CASNGMTEELlPVC N DFA.OF WELL CASINO AIA 0 ❑ PUSLICIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL 10 SPECIFICATION OA m ❑ IIMSGATIONIAG ❑OTHER GROUT SEAL INSTALLED SY {t1/VN+`i GROUT BRAND NAME b 14aTJ'L- E ba-MONITORING GROUT SFAL PUMPED: ❑Ym NK* CONCRETE PEDESTAL BY DRILLER❑Yr S APP%OX.DEPTH LOCKING CHESTER ROAMTOVE RPE ,[�p 5 PROPOSED CONGTRUCTIONIDMIJING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHERX_PS PT' 1 HEREBY CERTIFY THAT 1 HAVE PREPARED TH19 APP ICAT90H AND THAT THE WORK WILL BE DONE 1N A CORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTI IES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT 16 ISSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LA OF CALIFORNIA.' CONTRACTOR'S WNNO OR BUB-CONTRACTINO SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT N 711E PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT 18 1 INVED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPONSATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL 24 NOURS IN ADVANCE FOR ALL FMGU1RSD I ISPECTIONR A 12091 4M'*4"- COMPLETE ORAWt NO AT LOWER AREA 1PROVIDED. SW*d X Titlebate I Z Igg PLOT PLAN Ibraw to SeeM)8aele 'to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, 4. LOCATION OF HOUSE SEWAGE D18POSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERryI GIVING DIMENSIONS AND NORTH DITrtCTK7N, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OVTLW..B AND LOCATION OF ALL EXISr1NG AND PROPOSED S. LOCATION OF WELLS WRHDN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,ORVEWAY8 AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY_ -" APPROX. 60 FEET OF'REMOTE-FILL PIPELINE LEGEND: ' - ® TANK SAMPLE LOCATION PROPOSED SOIL BORING - 01)44/ 016 TANK E APPROX. LIMIT OF EXCAVATION ., 025 / - 017 VENT LINE (APPROX. LOCATION) PRODUCT SUPPLY PIPING - - - _.. (APPROX. LOCATION) ;. :... .:.. .. -... ❑ .. .... .. II BUILDING DIESEL SUPPLY INTO BUILDING ��11ri A!!1llEX�-1fAAfA - - VENT INTO BUILDING WATER INTO BUILDING STOCKTON UNIFIED SCHOOL DISTRICT EDISON NIGH SCHOOL NATURAL GAS LINE INTO.BUILDING - - PROPOSED SDII. BORING LOCATlOIJ _ i R r veE "LY Application Aaveptad Br DalA-2 Mea 431"IMpeeflen by Date Resp Impee B Date Da UmIlen ImpxHan By Data LommarNe: ACCOUNTINO ONLY: AID/ FAC/ PE CODESFEE fNFO AMOUNT REMITTED CHECKIICASH R C By ATE P9TMITISERVICE REOVEST NUMSfHi INVOICE 0J## Pub Health Serv.•Enviro.173(1197)