Laserfiche WebLink
0 <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> PRO,BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> (20914811-3420 <br /> NONREFUNDABLE OENMIT WINES 1 YEAH FNDM DATE ISSUED <br /> ICAIIpkto In TIIpNIaI/I <br /> APPLICATION 15 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRLICT ANDER WSTALL THE WORK DESCRIBED.TM APPLICATION 18 MADE M COMPIJANCE WITH SAN <br /> JOAOUIN COUNT'DEVELOPMENT TITLE CHAPTER 8-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUI)C HEALTH SERVICES,ENVMIOMAENFAL HEALTH DIVISION. <br /> JOB ADORE/Avn,wN/ S 7� /iLN t �4Y r cm �!^3 C;c-/ PARCEL aaEIAP;M <br /> OWNE1'S NAME AGGRESS 7! / 7 <br /> �'c ���r /ryr Y/a spa G HANE <br /> CONTRACTOR_ iADDRES6 / ' // 3PHONE/ <br /> SUS CONTRACTOR ADDRESS <br /> _ PHONE I <br /> TYPE OF WEUJRJMP: ❑NEW WELL ❑REPLACEMENT WELL ❑MONITORUNG WELL P �+ ❑OTHER <br /> ❑INSTAALLLLATION ❑WELLlsmEM RWAIR Cl CROSS-CONNECT REPAIR ❑VAPOR EXTNLCTION WELL/ JJ,` <br /> 11N—TER-.. M.P. DEPTH PUMP SFT-J,�6)FT. FIRST WATER LEVET k � <br /> R OF PVMPI I(� <br /> ❑OVTOFDERVICE WELL ❑GEOPHYSICAL WELL/ ❑ NOR SOMM �JA <br /> ❑DEITRUCTION. --•1 <br /> NT—MMD LNC YPS OR CONSTR= SPECIFLCATIONA A <br /> ❑ NDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO D� <br /> ❑ DOMESTIC/PNVATE ❑GRAVEL PACK/SRE_ TYPE OF CASINONTEELA V DIA.OF WELL CASINO \ p <br /> ❑ PUSUCMUNICIPAL ❑DPIVEN DEPTH OF GROUT SEAL SPECIFICATION R <br /> ❑ WfWATION/AG ❑OTHER GROUT SEAL INSTALLED BY _ ORDVT DRAW NAME -751 <br /> ❑ MONITORNO GROUT SEAL PUMPED:❑Y- [IN. CONCRETE PEDESTAL BY DRILLER,❑Y- ❑Ne 03 <br /> APPROX.OEPTM LOCKING CHESTER BOXMTOVE PRE <br /> PROPOSED CONSTRVCTION/DRILLING METHOD: MUD ROTARY_ AIR ROTARY AUGER CABLE OTHER <br /> I HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPUCA1.14 AND THAT THE WORK WILL tE GONE IN ACCOPIDANP:E WITH SAN JOAQUIN COUNTY ORDINANCES.STATE LAWS,ANO RULES AND <br /> REGULATIONS Of THE SAN JOAQUIN COWRY,HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTRES THE'!OLLOWIIMG:'I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH <br /> THIS PEAM#T IS MBUED.I SHALL NOT EMPLOY PERIDNA SUBJECT TO WORXMAN'S COMPENSATION LAWS OF CALIFORNIA.'CONTRACTOR'S MRNO OR SWPCONTRACTINO IIIONATLRIE CERTIF1Et <br /> THE FOLLOWING: 1 CERTIFY THAT IN THE PERFORMANCE Of THE WEIR•OR WHICH THIS PERMIT 19(SUED,I-SHALL EMPLOY PERSONS SURRCT TO WOISOHAN'S COMPENSATION LAW[OF <br /> C/WFOIWIA.' /M CANT MUST CALL <br /> LM NOW IN ADVANCE PON ALL REOUIMIX)MA�PICTIONS AT 12r'S)ISS-Sir.COMPLETE DRAWING AT LOWER AREA PROVIDED <br /> aw-d% �--�Lf�J <br /> ROT PLAN M.—I.Sa. SuI& 'co <br /> 1 NAMES OF QTMIS OR ROADS NEAREST TO CR BOUNDNO THE PRDPWrY. 4. LOCATION OF HOUSE SEWAGE OESPUM SYSTEM OR PROPOSED <br /> 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMB. <br /> 7. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED B. LOCATION OF WELLS V41"III RADIUS OF ONE ML440FWD FIFTY FT, <br /> STRUCTURES,INCLUDING COVERED AREA9 SUCH AS PATIOS,DRIVEWAYS,AND WALKl. ON THE PROPERTY OR ADJOINING PMOPERTY. <br /> .. . <br /> �,PAYMIENT <br /> .. ECEIVED.:. ... . <br /> o _ .. _ . .wft •AUG -5199T <br /> 7 s <br /> $ANJOA�U�N COUNTY <br /> Pusuc H M SERVICES DW5ION <br /> lG, .lj-e 94 <br /> DEPARTMENT USE ONLY 7� <br /> AP 11-4. AmWt d IT_ D.1. _A— <br /> a,—I—P-1—By 1. P—P 1—0—BY 'DN.. <br /> O-Ir�ctlen kn ll—BY D-. <br /> ACCOW TIRO ONLY: AAI FACT <br /> PC COD"/ I FR.. AMOUNT ROWITTED . /.ASN RECEIVED a OAT[ /SYIVICE a NVOIC! <br />