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02-14-'07 08;17 FROM-PTTi3ON & MURPHY 1-209-334-072' T-307 P02/04 U-313 <br /> APPLICATION FOR WELLJPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209)468-3420 <br /> NOI4REFUNOARLE PERMIT EMNES 1 YEAR FROM DATE ISSUED <br /> (Complete M TTipReval <br /> APPLICATION IS 1/EAE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AROMA INSTALL THE WORK DE9CraREO.THIS APPLICATION IS MADE IN COMPLIANCE WrTll SAN <br /> JOAQUIN COUNTY DEVEL.OPM NT TITLE.CHAPTER B-1116.3 AND THE STANDARDS OF RAN JOAOUIN COUNTY PUBLIC HEALTH 0ENVICE9,ENVIRONMENTAL HEALTH ONISION. <br /> Cy I <br /> JOR AOORESSA7A APP�]N/ ! L /� I CrtY C� PARCEL BIYE/APNI <br /> OWNER'S NAME /L '-Cf �t9'Ltl..t 8r f / <br /> c•7 `3,L!-o L/7_2 <br /> CONTRACTOR �"� 'ul-'C-.�.,r'� -� U ADORES• (- 7�. LICI I" 3,3 7 3 PHONE f fl q ry -) <br /> RUR CONTRACTORI-�ff AbOMOR LIcY PHONE f <br /> TYPE OF WELLNUMP-, ❑ NEW WELL 0 REPLACEMENT WELL ❑ MONITORING WELL• ❑ OCHER <br /> ❑ INSTALLATION ❑WELL SYSTEM REPAIR ❑ CRORB-CONNECT REPAIR Q VAPOR EXTRACTION WELLf J <br /> ❑N..Y❑R.p.lr H,P. — DEPTH PUMP RETJ r�,, FIRST WATER LEVEL, O� <br /> R VPE OF PllMPI <br /> ❑ OUf or.SERVIGc WELL ❑ aEOPHYerc AL WELL$ 1•J SOIL BORING S I 1 <br /> I.J DESTRUCTION; <br /> 1NTENDED USE /rR <br /> T YK OF WELL cGNs rRVC TIOM SPECIFICATIONS A <br /> WND <br /> INDUSTRIAL El OPEN BOTTOM DIA.Of WELL EXCAVATION DIA.OF CONDUCTOR CASINO O� <br /> .J LDOMESTICIPRIVATE a GRAVEL PACK/SIZE TYPE Of CASIN0/9TEEI/PUC DIA.OF WELL CASINO Ob' <br /> tEl WBLICMUMC1PAL ❑DRIVEN DEPTH OF OROVT SEAL 9PECTFICATFON R <br /> LJ IMMOATIONIAO ❑OTHER OROUT SEAL INSTALLIEO�BTY GnOVT SPAM NAME F <br /> 11MONRfORING OROVT SEAL FVMKI); L.,E Yr ❑N. CONCRETE PEDESTAL 11Y OMUER:❑Yr 0M. B.N <br /> APMIOX.DEPTH LOCKINB CNESTER ROX/STOVE PN°F <br /> l <br /> PLOPOSIM CONOTAUCTION/DI LUNO METHOD: MUD ROTARY AIR ROTARY AUOfR CABLE OTHER <br /> I HEREBY CERtWY T04AY I IIAVE PREPARED TIME AFFIXATION AND THAT THE WOFNL WILL RE DONE 1N ACCORnANCF WITH SAN JOAOUIN COUNTY ORDINANCES,@TATE LAWN.AND RVL.ES AND <br /> REOULATIONS OF THE RAN JOAOVN COUNTY, NOME OWNER OR LICEN9E0 AOENrue SIGNATURE CEIITIFIFS THE FOUOWOMa '1 CERtIVY THAT N THE PEPlOFM1ANCE OF THE WORK FOR WIUCH <br /> TH10 PERMrT M ISSUED,1 SHALL NOT EMPLOY PERSONS KMJECT TO WORKMAN'S COMPENSATION LAW%OF CAUFOPSNA.' CONTRACTOR'R HIRING OR SUS CONTNACTMO BIONATURE CERTIFIES <br /> TINE FOLLOWINNI: 'I CERTIFY THAT N THE PERFORMANCE Of THE WOW FOR WHICH TINS PEPMIT IS IBSVED,1 SHALL EMKOY PERSONS BVBJECT TO WORIONAN'S COMMNSATIPN LAWS Of <br /> CALfORNIA.' PPUCART MVST CALL 24 FIOUNS IN ADVANCR FOR ALL MOR R/m DNsrtcMMI4S AT 1204140444". COMPLA:TE DFIAW"u AT LOWER AREA PROVIDED, <br /> ibn.a X C � Tf '—"li'!_/ _ ____- bM• La 7 <br /> PLOT PIAN 1D,RM/I.S.4.1 S.M. 'to <br /> 1. NAMES Of STREETS OR ROADS REARREST TO OR BOU IOFNO THE P110"ArY, A. LOCATION OF HOUR£SEWAGE DISPOSAL SYSTEM OR PROF`06E0 <br /> 2. oUTLNE Of THF PROPERTY,ON1000 DWENSRONS AHO NORTH DIRECTION. EXPANSION OF SEWAOE MOV-t SAL SYStEMS. <br /> 7. DMAEHOONED OUTUNT..S AND LOCATION Of ALL fXFSTNNO AND PROPOBEO S. LOCATION OF WELLS vvm"N RAM41 OF ONE HUNDRED fIFTY FT. <br /> STRUCiVRES,S4 WAN0 COVEM AREAS BUCH AS PATIOS,DRIVEWAYS,MIO WAL 11. ON THE PFIOPERTY OR ADJO]IMM PROPERTY. <br /> A <br /> c ... <br /> : <br /> • <br /> i <br /> i <br /> .ep <br /> PAYMENT' <br /> ,.E1VE ' <br /> JUN 3.0 1998 <br /> UN N JN <br /> PC AVi <br /> 5 <br /> EIVIRONMEL H�AL7 01VIS <br /> IC^+. <br /> I <br />