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SU0012547
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SU0012547
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Entry Properties
Last modified
11/5/2019 2:30:28 PM
Creation date
11/5/2019 2:27:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0012547
PE
2631
FACILITY_NAME
PA-1900046
STREET_NUMBER
1123
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
STOCKTON
Zip
95215-
APN
10320008
ENTERED_DATE
9/13/2019 12:00:00 AM
SITE_LOCATION
1123 N JACK TONE RD
RECEIVED_DATE
9/13/2019 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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TSok
Tags
EHD - Public
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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 'r0 P.O.BOX 388,964 EAST WEBER AVENUE,STOCKTON,CA 95201588 <br /> 1 v (2091 489-3420 <br /> 1101-REFUNDAILE PERMIT EXPIRE!T YEAR FROM DATE 13SUED <br /> M-mp11If M TripMmtol <br /> APPLICATION 18 HERE[Y MADE TO THE SAN JOAOVIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOIL NSTALL THE WORK DESCRXIlD.THIS APPLICATION 18 MADE N COMPLIAHCF WITH SAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE,CHAPTER/{9--1/116.3 AND THE STANDARDS OF SAN JOAOUIN COUNTY PUBLIC HEALTH SEIVOC'ES,ENVIRONMENTAL HEALTH DfVMON. <br /> PARCEL MZVAPN9 <br /> OWNER'S NAM, AopEBS PN)NE <br /> CONTRACTOR <br /> f <br /> AMMER$ �J PHONE 4-- <br /> WS COMMCTOq ADDRESS LICS Sc PHONE P <br /> Type OP OS HINr WELL ❑REPLACEMENT NRLL ❑MONRORHO WELL I ClFE <br /> OTT_ <br /> /❑�N/TAiLA7NMI ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT WPAR ❑VAPOR ORgACTION WELL f <br /> ❑N—❑NqM. H.►- DEPTH RUMP SET--'FT, FIRST WAtFH LEVEL D <br /> TYPE OF PRIMP) <br /> ❑OUT OF-SERVICE WELL ❑OEOPHYBICAL WELL f ❑ SOIL WRING d <br /> ❑ <br /> DESTRUCTION:- <br /> WTmoto Udc tym 6y WELL CONAM901014 SPMFICATIOks SPECIFICATIONSA <br /> i <br /> INDUSTRIAL I-]OPEN BDROM DIA.OF WELL EXCAVATION DU.OF CONDUCTOR CASINO- p <br /> ;RDOMERICIPNVATE 43qPIAVEL PAC ISIZt TYPE OF CASING/BTFEIM/C // <br /> PIA.OF WELL CASINO p <br /> ❑PUSL1CMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL _ SPECIFICATION •.•— A <br /> ❑IRSOATIOWAO ❑OTHER OROUT SEAL INfTALLED 61' _ GROUT MANS HANE E <br /> ❑MOWTOPoNO JJ OROUR ZEAL P UMPOj;aYr ❑N. CONCRETE PEOESTAL■ ILLEIL❑Yr 394. <br /> A/P110 X.bf►TN� LOMINO CHESTER SOXATOVE RPE_ d <br /> PROPONm CONSTRUC7roNmmLUNO METHOD: MUD ROTARY_ ` AR ROTARY <br /> AUGER.__CAdll OTHER <br /> I HERESY CERTIFY THAT 1 HAVE PREPARED tM t APPLICATIONANO 1'4AT THE WORK VOL BE DONE N ACCOIIOANCE WITH SAN JOAOUN COUNTY OPIDINANCEI,STAT!UNP,AND RUES AND <br /> REGULATIONS OF THE SAN JOAOUN COUNTY.HOME OWNER OR UCtNfEo AGOMS SIGNATURE CERTIFIES THE FJLLOWINO:'I CETRF/THAT N TW PEKOPWAANCE OF THE WIOPK FOR WHICH , <br /> THIS PERMT 18 ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WOMWAM'S COMPROATION LAWS OF CAIO(NNU.-CONTRACTOR'S FIPRM OR SUS-CONTRACTSiG SIGNATURE CERTIFIE7 ' <br /> THE FOLLOWING; 'I CNITIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT M If SUED I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPSKIIATION LAWN OF <br /> CAUFOMA--�T/N/.i�APPLICANT <br /> �NRAET CALL 24� W N ADVANCE FOR ALL q[OUREb INNPSCTpN&AT I2O01400�=,COMPETE DRAWING AT LOWER AREA PRO�VKXD. <br /> SIeW% V (IL r✓lQ/1��{A'Y� Tltl• �N 1 11& OM.L.Z 7:p <br /> PLOT PAR ID'...m 6e 1 G`. <br /> •I. <br /> I.NAMES Of STREETS OR ROAOS NEAREST To OR MUNOINO THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE OIWOSAL SYSTEM OR PIIOPOKO <br /> Z.OUTLINE OF THE PROPERTY. N <br /> Y,ONIp DIMENSIONS ANO NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYS7EE.N, <br /> 3. OIM,NSIONED OUTLINES AND LOCATION Of ALL EXISTING AND PHOPOSEO S. LOCATION OF WELLS VJRIRN RADMS OF ONE MJHD REO FIFTY FT <br /> STRUCTUMS,NCLVDINO COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,MIO WALL:S, ON THE PROPERTY OR ADJOINIIIO PIIOPERTY, <br /> ZZ <br /> ..:..... ... ..t.. v <br /> i <br /> : <br /> .....:.....: <br /> ... .. .. <br /> : <br /> , <br /> < <br /> -F <br /> l <br /> .. •�B°-:6..1998 . ..... <br /> 19 <br /> <: x <br /> .. <br /> ::... <br /> :SAry'JOAOUIJu WUMTY ,: <br /> 'FU9Ji.HF~J+I.+HSERVICCb: `• •••! <br /> .`:. 4NVIHON6IEwAL HSALi:K yNF$IUPi:. ..I. <br /> • .....� ...f...:.:. . .. .. .. ..._... . . . . <br /> i <br /> D�MTMBIT USE OMLT <br /> APPIbMbn ACogl.a BT �i <br /> 1AN ANS <br /> GPeUI In.pr[bn eY �� DK. PM*:P InIP.INen 61' DfN <br /> Drinrwn 1rwP.vtb.i By . <br /> SAI. <br /> C:'E 1 {dl}{L� ��-•�- t �, — Z. 4. �tlL61ro t�:v b <br /> ACCOV01""O ONLY: RIO! FACE <br /> PE COD" FEE INFO AMOUNT ROAMED CHIC NH R[CCVE(I[Y .ATE P91WT/{p1VIC6 RFOIIEI SI IPNOIC[ <br /> 4117 <br />
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