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eo� AY4 <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION AUG 3 1 10,98 <br /> 304 FAST WEBER AVENUE, STOCKTON, CA 952.02 <br /> (209) 468 <br /> -3420 <br /> NOR-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> memplels In TrIpIkatel <br /> APPLICATION 19 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW MSCTUSEO,THIS APPLICATION 08 MADE IN COMPLIANCE WITH SAN <br /> JOAQUIN COUNTY DEVELOPMENT TfTLE,CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC. <br /> UBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> JOB ADDRESSIOA APNl9 11055 N, Statwy e H88 -CITY Stockton PARCEL SIZEIAPNO <br /> OWNER-8 NAME Marta/Pete Paras A11111 11055 N..`­&t. Hwy 88 ----PH0NE0 368-7337 <br /> CONTRACTOR HENNINGS -BROS, DRILLING CO. INC. ADDRESS 3525 PELANDALE MOD uc, 290813 mome, 545-1185 <br /> PUS CONTRACTOR ADDRESS uce PHONE 0 <br /> TYPE OF WELLMUNIP; 0 NEW WELL ❑ REPLACEMENT WELL t] mos4rmpma vvEur 13 OTHER <br /> IJ INSTALLATION ❑ WELL SYSTEM REPAIR ©'CROSS-CONNECT REPAIR 1:1 VAPOR EXTRACTION WELL# <br /> 0 New 0 Rmeelr ".P- DEPTH PUMP SET FF. FIRST WATER LEVEL <br /> (TYPE OF PUMPI <br /> 1211X1601 0 OUT-OF-SEnvice WILL 0 GEOPHYSICAL WELL' 13 SOIL BORING <br /> 06119TRUCTION! AS per county-Cement pumped from bottom-up. .9 sack mix slurry <br /> INTENDED USE TYPE O W CONSTRUCTION SPECIFICATIONS A <br /> 0 INDUSTRIAL. 0 OPEN sorrom DIA.OF WELL EXCAVATION VIA.OF CONDUCTOR CASING a <br /> 11 DOMESTICIPRIVATE 0 GRAVEL PACKISIZE TYPE OF CASINGIGTEELIPM VIA,OF WELL CASING 0 <br /> 11 PUSLICIMUNICIPAL 11 DRIVEN DEPTH OF GROUT SEAL SPECIFICATION R <br /> 0 tFIRIGATIONIAG 00THER GROUT SEAL INSTALLED BY GROUT BRAND NAME E <br /> 0 MONITORING GROUT SEAL PUMPFOi 11 Yes [IN. CONCRETE PEDESTAL BYOPJLLEFI:Elyo Due s <br /> AP X.DEPTH LOCKING CHESTER BOX/STO%M PIPE <br /> PROPOSED CONSTRUCTIONIDAILLINa METHOD' MUD ROTARY AIR ROTARY AUGER_CABLE OTHER <br /> I HEREBY CERTIFY TRAY I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND RULES AND <br /> REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING,'I CERTIFY THAT IN T14E PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PERMIT 19 ISSUED,I 914ALL HOT EMPLOY PERSONS SUBJECT TO WOVAMAN'S COMPENSATION LAWS Of CALIFORNIA.- CONTRACTOR'*HIRING OR SUS-CONTRACTING SIGNATURE CERTIFIES <br /> THE FOLLOWING: -I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 18 ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS Of <br /> CALIFORMa. THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL RtGUIRED INSPECTIONS At 1209144194422. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br /> '� <br /> 84med ipbm TI U L2]1A .. 8-24-98 <br /> PLOT PLAN 01 to Sahel goale— to <br /> 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br /> 2. OUTLINE Of THE PMPtMY,GIVING DIMIENSM)NO AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> Z. DIMENSIONED OUTLINES AND LOCATION OF ALL fXt8tffM AND PROPOSED S. LOCATION OF WELLS WITHIN RAMS Of ONE HUNDRED FIFTY FT. <br /> STRUCTURES,INCLUDING COVERED AREAS 6UCH AS PATIOS,DRIVEWAYS.AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> f ........... <br /> me. <br /> ;A1 <br /> v ...... .... <br /> % <br /> I. <br /> m <br /> . <br /> T`v <br /> 4998 <br /> q <br /> 0— <br /> T Q <br /> F' <br /> . .... ....... 7 4. <br /> SAN JOAQUI WC01-)N f'i <br /> NVIRONMENTAL.HEL,4TH DI\031 <br /> oe <br /> Appiloatlon Accepted By A," <br /> Omit kwpectlon By —noteF4fmp Inspectlon By Dats- <br /> amormillon Impection By Date 2- rz <br /> ACCOUNTRIO ONLY: AID$ FACT <br /> PE CODES FEE INFO AMOUNT REMITTED CHI.CK#ICASH RECEIVEcqD PW BY DATE IMITIS Cl FIT=NUR45OR 4mveace <br /> —7 <br /> Q <br />