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VtlUNP APATIOH FOR WELL)PUMP PER SAN J0 N COUNTY PUBLIC HEALTH SERVICES # C Q R ' s EldviiONMENTAL HEALTH DIVISION L P,O.BOX 988,304 EAST WEBER AVENUE,STOCKfON,CA 95201388 Cs�l� (204)468-3420 NON-REFUNDABLE PERMIT EXPIRES f YEAR FROM DATE ISSUED lromplots In b1pikals) APPLICATION 19 HERE BY MAGE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK btkRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WRIP$A JOAQUIN COUNTY DEVELOPMENT TNLE.CHAPTER 9-111 S.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADbREBS/OR APMr 10480 N Highway 99 (KWIN Tower) CITY Stockton 086-070-34 PARCEL SIZEIApNR OWNEA'S NAME Silverado Broadcast ing ADDRESS 6320 Pacific Avenue 8200 Stockton, �ONEF 209 476 1230 CONTRACTOR Earthtec, Ltd ADDRESS 1830 Vernon Street 87 Ranville, pHbNE$16 786 5262 SUBCONTRACTOR 406595 1 ADDRESS LICK PHONE f TYPE OF WELLIPUMP: ❑NEW WELL ❑REPLACEMENT WELL ❑MONITORING WELL f 1.3 OTHER GEOT£CHN I CAI. SOIL BOR iNG 11 INSTALLATION [I WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELLF ❑F Nwv❑Repatr H.P. DEPTH RUMP SET FT. FIRST WATER LEVEL iIYPE OF PtlMq -- � ❑OVT-OF-SERVICE WELL ❑GEOPHYSICAL WELL f SOIL BORING e ❑DESTRUCTION: ' �+, INTENDED UAE 17""OF WELL CDNSTgUC RON SPECIFICATIONS ❑INWSTPoAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONOUCyORCABINO A ❑DOMESTIUPRIVATE ❑GRAVEL PACK/617E TYPE OF CASINGlSTEELIPVC DIA,OF N2 CASINO 0 ❑PUBUCIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL SPECIFICS�.O.N�El IRpIGATION/AQ OTHER GROUT SEAL INSTALLED BV GROIfTAME ERE❑MONITORING GROVT SEAL PUMFEb:❑Yr C3Ne CErTU BY DRILLER:OYr E APPROX.DEPTH A rox 501 LOCKING CHESTER BOX/STOVE RPE l PPROPOSEDCGNSTRIICI'1ON>deLUNG METHOD: MUD S ROTARY AIR NOTARY AUGER_ CABLE OTHER I HF9EBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOry;WILL BE OONE IN ACCORDANCE WITH SAN JOAGUIN COUNTY ORDINANCES.STATE LAWS,AND RULES ANI REGULATIONS OF THE SAN JOAQUIN CDUWY. NOME OWNER OR LICENSED AGENT'S SIONATURE CEIITIFIES THE FOLLOWING:•I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICI THIS PERMIT IS 4SSUED.I SHALL NOT EMPLOY PERSONS SURJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA. THE 'FOLLOWING: •1 CERTIFY THAT IN THE PEN{FORMANCE OF THE WORK FOR WHICH THIS F'ERMR CONTRACTOR'S HIRING OR SVBZONTRACTINO SIGNATURE CEm[FIEI IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S C CALIFORNIA.' THE APPLICANT MUST OMPF7LBATON LAWS O FOR ALL REQUIRED INSREOTTONA AT 1211614/JCALL 24 HOURS IN ADVANCE 6 6:3423.COMPLETE DRAWING AT LOWER AREA PROVIDED, 814—d X TMp PrinrlciDal Consultant Oa. 6/15/00 PLAT PLAN ID—to FiWel f;I. -,u - I. NAMES OF STREET.OR ROADS NEAREST TO OR BOUNDING THE".,;I;' 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY.OIMNO DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. bIMENCIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. ..SEE ATTACHtD.MAP ..j, R GEOTECHNICAL ONLY RCS 14' L ',... .: .... f 10�X 14' LEASE ARF,.4 I o El V 04 194.,9x1 MIR ❑ NoTr REGI �� I f 20�� > � p0�eAil 11KR i L I Sass yO Hoy E��o�Stion °m"` LDz% ! L1 SEN 'riF-P - Tof CLER AND OCE LAN! Y SUlIECr TELEL SE EPHONE SERNCE TO APN: 086-07D-34 NO CHE ICA TESTING I.D.��ELS tib¢ F TLS.E Rae-r xI,N rowve BXHIBIT B M Kwll A TDweSAA ,..r,+>c,uep• DRAFT-NOT TO SOME :...' _.,....... _.... .. .,,.... ....... O-:._SSSS:,,, :...,,. Ell DEPARTMENTVSE ONLY APPIIceliPn Accepted BY L O� �7 7 '` Ste A.r GIPut Imp Ilon B Daa (i U(l P—P 1.- 11-BY Dae DearUctfen IrypaFtfon BY - Dae , i I ACCOUNTING ONLY: AIDI PF COQE6 FEE RkFO AMOUNT REMITTED CHECK#1CASH RECEIVED BY O E PFRMITIAEAVICE REQUEST NUMBIR INVOICE to