SITE INFORMATION AND CORRESPONDENCE FILE 1

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1.2. Definitions, items or conditions not specifically outlined in these standards may be addressed in the State of California Water Well Standards Bulletins 74-81 and 74-90, or regulated on a site specific basis by the Environmental Health Division of San Joaquin County Public Health Services. 2. PERI MS 2.1. An application for a permit is required for a Well, including: Geotechnical, Geophysical, Recharge, Reconditioning, Deepening, Cathodic Protection, Monitoring*, Test Well, Subsurface Boring, Injection, Extraction, and Vapor Probe. (*See Section 13 for Monitoring Well Construction Requirements) 2.1.1. The licensed well contractor (C-57), or his authorized representative, shall make application on forms furnished by the San Joaquin County Public Health Services, Environmental Health Division. The application shall contain the following information and a plot plan drawn to scale. 2.1.1.1 Owner's name and address. 2.1.1.2 Address of parcel and/or Assessor's parcel number (A.P.N.) 2.1.1.3 Names of streets or roads nearest to, or bordering the property. 2.1.1.4 Outline of the property giving dimensions and North direction. 2.1.1.5 Dimensioned outlines and locations of all existing and proposed structures, including covered areas such as patios, driveways and walkways. 2.1.1.6 Location of house sewer outlet, public sewer, sewage disposal system or proposed sewage disposal system, proposed expansion of sewage disposal system, or any other possible source of contamination. 2.1.1.7 Location of proposed new well, other existing wells and sewage disposal systems within a radius of 100 feet on the property or adjoining property. 2.1.1.8 Intended use of the well. 2.1.1.9 Name, address and license number of licensed well driller/pump contractor. 2.1.1.10 Note on permit application if the well is in a flood plain or drainage course. 2.2. A pump permit shall be required anytime the sanitary seal on the well head is removed. 2.2.1. The owner of the property or the appropriate licensed well or pump contractor shall make application on forms furnished by PHS-EHD. 2.2.2. The installation or repair of a pump will require a plot plan showing the location of the well and pump and any structures. 2.2.3 If pump and motor are not installed by the well contractor, approval of the well construction will be given for the contracted work and a separate permit shall be obtained for installing the pump and motor. 2.3. An application for a-permit is required -for- the-elimination-of-a-cross-connection at the well discharge. 2.4. The approved permit shall be good for one (1) year from date of issue. Extension may be granted by the Director for one additional year. 6