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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES UUELL / PUMP <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> POR-REFURDAREE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IC9mplet/ In Trlptle/111 <br /> APFTICATION 19 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRBED.THIS AM ICATION 18 MADE IN COMPLIANCE WDII SAN <br /> JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1116.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES.ENVIRONMENTAL HEALTH DMSIOW <br /> JOB ADDRES9MR ARU 7367 East Mariposa Road Cm, Stockton PARCEL SUVAPNI <br /> OWNTR'8 NAME Murray Industrial PropertiegUVM„ 1754 E Mariposa Rd MwNE,466-0266 <br /> CONTRACTOR Clark Well , Inc . AooRE„2024 E Charter LID, 371560PHONE0462-7676 <br /> SUS CONTRACTOR ADDRESS UCI PRONE I <br /> TYPE OF WELLMUMP: ❑ NAY WELL ❑ PEPLJICEMENT WELL ❑ MONOONNG WELL• ❑ OTHER <br /> ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL I ✓ <br /> ❑N.w❑iuRM N.P. DEPTH PUMP MT-FT. FIR”WATER LEVEL D <br /> RYPE OF PUMPI <br /> ❑ OUT-0E-BERVOE WELL ❑ OEOPNV6ICAL WELL1 8011 / <br /> ❑OEBTRIICTIDN: U '( WE�I. 1' -UE ��►'?ED FAlM "dol'foH 7n —1 Ft U.- CEll£NJ inoW Sj^ <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A <br /> ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO O <br /> ❑ DOMESTICIP'RVATE ❑GRAVEL PACKISIZE TYPE OF CASINOMTEEVPVC DIA,OF WELL CASINO D <br /> ❑ PURLICA1UmCIPAL ❑DRIVEN DEPTH OF GROUT SEAL SPECIFICATION F <br /> ❑ IRRIGATIONIAU ❑OTHER GROUT BUL MSTALLEO BY GROW BRAND NAME E <br /> ❑ MOMTONNO GROUT SEAL PUMPED: Ely. ❑Ne CONCRETE PEDESTAL BY DRILLER:❑Y� ❑NP 5 <br /> APPROX.DEPTH LOCKINO CHESTER BOXISTOVE RPE 5 <br /> RMOPOSFD NSTIVCTIONIDISIUNO METNOW MUD ROTARY AIR FIOTARV AIRIER CAftu OTHER <br /> 1 HEREBY ERT FY THAT I IIAVE PwgEO THIjAA bN t0A <br /> 9R[WILL BE DONE M ACCORDANCE WITH SAN JOADVIN COUNTY ORDINANCEC,STATE UW6.ANO RI1lE6 ANO <br /> nEGt1UTl NB F M BAN JO W CO R ENT'a SIGNATURE CFRTIF1E8THEFOLLOWINO:'I CERTIFYTHAT MTHE PERFORMANCE OFTIREWOFKFORWHICH <br /> TMS PE I DED.181,A NIJ EM O ACY COMFfNSATON LAWS OF CALIFORNIA.- CONTRACTOR'S NINNG OR SUS-CONTRACTING SIGNATURE CERTIFIES <br /> THE FO O 1 CERTIFY NAT M PEOFWHICH TMB PERMIT 10 ISSUED,I MAU EMPLOY PERSONS SUBJECT TO WORKMAN'/COMPENSATION LAWS OF <br /> CAUFO A.' T C / 3AOUFAM INSFSCMAIS AT 13081 4/04/3/. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br /> BIprE TRH. Sec-Tres D .12/11/98 <br /> ROT0.1 Bv.18 '1. <br /> 1. NAMES OF STREETS OR RO NEAREST TONDING 4. LOCATION Of HOUSE SEWAGE DISPOSAL SYSTEM OR PT10RV eft, <br /> 3. OUTLINE OF THE RIOPERTY O DIMENSIONS AND NORTH DIDECTON. EXPANSION OF BEWARE DISPOSAL SYSTEMS. <br /> 3. DIMENBMWO OUTLINES A DCATMN OF ALL EXISTMO AND PROPOSED S. LOCATION OF WELLS WITHIN MONS OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES,IMLUDING COVERED AREAS SUCH A9 PATIOS,DRVEWAY8.ANO WALKS, ON THE PROPERTY OR"JOINING PROPERTY. <br /> �I <br /> , �►� r <br /> DEC 11 1998 <br /> SAI,I(JSLJCH.IUAgUIN I" <br /> ENVIRONMEN-A NE <br /> EALTN <br /> OWARTMENT USE ONLY <br /> APPII..eeo X.SPI-I By - I • _. - _ _ . ON. ( e A,. <br /> m.M IrwP..lbn er G.I. n..v Imv..Ilen er D.I. <br /> nwbmlbn b..n..I1m er I D.I. /2 .29 9E) <br /> c«.msr. /Z •249B Z NO Er��d 7T/•.I To 7,op 4�6 <br /> ACCOUnrwO oMv: AIDE FACF <br /> PE CODES FEE INFO AMOUNT RFNIITTEOCNE/C ICA/N MCOVEO BY GATE POEMITISERVICE REQUEST NUMBER INVOICE <br /> 73 A 2;z 6ioT) <br /> Pub Health SON.-EnvirO.173(1197) <br />