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Waiver <br /> Wel l Permit Number: _1 O <br /> This application is made for a waiver of the minimums ck dues required by San <br /> Joaquin County Well Standards. <br /> Site Address: 800 West Mossdale Road,Lathrop,CA 95330 <br /> APN: 239-030-080 <br /> This Waiver is requested due to the following circumstances: <br /> The County well ordinance requires a 50 foot seal on irrigation wells. We are requesting to <br /> install a 60 to 70 foot deep well with 40 to 50 feet of screen.We do not want tounP dura clay <br /> layer at greater depths. Groundwater is approximately 10 feet bgs. The well will be usea intermittently <br /> for landscaping.We request a variance for a miutimurn 20 feet seal. <br /> Approved by: Date: <br /> 4egistffed��L <br /> nn <br /> rnmc cea th Specialist <br /> The following conditions are placed on the well construction permit and may not be <br /> modified: <br /> 1. The property owner shall sign this application and acknowledge that the minimum <br /> distance setback deviates from the minimum distance setback of Well Standards. <br /> I,the undersigned owner of the property identified above, hereby request a Waiver from <br /> the minimum distance setback of San Joaquin County on the information noted above. I <br /> acknowledge that this Waiver information should be disclosed to subsequent property <br /> owners. <br /> Signature of Property Owner- <br /> Print <br /> wnerPrint Name: <br /> Mailing Address: PO Box 1429,Lathrop,CA 95330-1429 <br />