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O ;Z o 9-7D <br /> A <br /> APPLICATION FOR WELLIPUMP 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 /> NON•RffUNDARLE PERMIT EXPIRES 1 YEAt FROM DATE MIND <br /> 1C.eIP114 M TFarMt@l <br /> APKICAMN is VFW BY(JADE TO THE SAN JOAOVIN COUNTY FOR A PERMIT TO CONSTRUCT AND10R INSTALL THE WjOW DESCRIBED.Tule APPLICATION IR MADE IN;•OMPIIANCF VITA BAN <br /> JOAOU114 COUNTY OEVTIOPMENT TrTLE,CHAPTER 1.1116.3 AND THE OTAHOMbO Of SAN JOAOUIH COUNTY PUBM HEALTII SERVICER,ENVIRONMENTAL HEALTH rMOFON. <br /> JOG A0011e&"APm 6000 Linne Rd. crry Tracy PARCELSIZEJArf1R <br /> OWNER'S HARM; D.M. Alegre Const. Inc. ADMIT P.O. Box 387, Tracy FHON(, 835-0243 <br /> CONTRACTOR Hen -cgs Bros. Drilling Co. . Inc. ATIT1E.. 3525 Pelandale.Mod.11t. 290813 F'HOHEf 545-1185 <br /> SUM CONTRACTOR FF����L��""'' I,^••�, ADORERB L1CI F"01*I <br /> rM to WELIJRJMP� a,{ktw WETL LJ REPLACEMENT WELL ❑ Mowc)"NO WELL. ❑ OTHER, <br /> ❑ O/RTALLATRNI ❑ WELL RY9TEV MPANI ❑ CROSS CONNECT REPAIR ❑ VAPOR EXTRACTION WELL! J <br /> ❑N.O R.A.k N.P. DEPTH PVIJP SET FT- FIRST WATER LEVEL O <br /> 0 YPE OF Ptium <br /> © oVT-0F.SERVICE WELL ❑ FIEOPIY.Ir AL WELL. ❑ .o..RORBrO <br /> �oESTRUCTIONt <br /> Ni ED W IM oft w OKCIFIC A <br /> CrylIHDVSTIOAI ❑••��OPEH1lOTTOM 01A•OfWILL EXCAVATION II (` DIA.OF CONDUCTORCASINO N/" n <br /> IJILOOME9TICAPRIVATE GaRAVEL PACLSAgE_ TYPE OF CASINOIOTFFIIPVt PVC <br /> C MA.OF WELL CAIPM 0 <br /> ❑ MJKX UUWrAL ❑OR.VEN OEPTFI OF OAOVT SEAL 100, _ OPECIFICATIOM 160 4 <br /> ❑ 1PRIGA1IONMO ❑OTHER GROUT sm OIRAll"fly driller OROUT RRAND NAME Bar i od E <br /> ❑ MOHTIONNO OR13UT SEAL PUMPED- ❑Y. ❑N. CONCRETE PEDESTAL RV w4l.LM:❑Y. pJ N. S <br /> AFFHO%.DWP'TH 2401 LOMINO CNESIER ROXMOVE PM4 s <br /> PROFOOSO CONSTTMICT'IOMIDAILLMO IIIETN00: AMA ROTARY—\_AIR ROTARY AUGER CARL! OTHER <br /> 1 HFREOY CERTIFY THAT I IIAVW~AFR:O TMS AT"AND THAT THE WOM WRL It DONE N ACCORDANCE MATH RMI JOAOUIH COUNTY OROWANCEO•STATE LAWS.AND RULES ANO <br /> MOULATIONO OF"SAN JOAOVN COUNTY, OWNER OR LICETI.ED A®ENT'R SMNATUBE CER TWX9 THT FOLLOvANOr'1 CER rWY THAT M THE FEMOFM/AMCE OF THE wow FOR WHICH ! <br /> TNI PEFMIFF 18 N9MO,I.HMI NOT EMPLOY NO VWXCT TO WOPWMAN'R COMPMOATHM LAWS OF CAISOPIRA.' CONTRIACTOR'S�X"OR SU"UNTRACTOIO SIGNATURE CERTIFIER <br /> T 'I CERTIFY THAT M TIO! E Of THE WORK FOR WHICH TF..PERMIT If ISSWJ.1 SHALL EMRLOY PERSON.*ALMCT TO WOPNMAWS COMPINSATTON LAWS OF <br /> CAiIFORMA. APPLICANT MUST'CALL 24 ADVANCE FOM AfL Rt0AN Ob.l PMN.AT IfM}440-3422. COMPJIF DRAWRLO AT LOWER AF&A PROYN)FD. Ill` <br /> „�% " i t1', 1 (f ;,ti,` � ,,� D.I. 11-3-98 <br /> -�'1 � , 1 <br /> T PLAN R7..w I.Re.M1 B..!. I. - <br /> 1. NAME@ OF lli OR ROADS 9T TO O HE P"OPOTTY, 4, LOCATON OF HOUSE'SEWAGE 040POW SYSTEM OR PROPOOEO <br /> 2. OVTLNE OF THE Pr OMRRY,WON!DME AMO TIUECTION. E%PANSM OF"AGE OIOPOM SYSTEMS. <br /> 2. DM.1E/N ONED Otn UNFR AND LOCATION OF % AND NVWOWD S. LOCATION OF WELLS WIrWN RAOMJS OF ONE IIIINDWO FIFTY FT. <br /> RTRUCTUft9,NCIIARNO COVERED AREAS RVC P R,DIRVEWAYR,AND WALXS. ON THE PMOPERTYOR ADJOINING PROPIATY. <br /> i <br /> LN <br /> _._ _.._---- �•� I NOV 5 1998 <br /> I . <br /> .� * ~�~ �� <br /> IVrr�\ <br /> „s <br /> "wA w USE GNLT �( ` <br /> Appilva"wo A~ed Illy b"9 <br /> awn b"vell.n ft b.n 23 n� h.nr Ir+Alellw�9T r.e. <br /> D."'i�3a��' �►fivrrf 17G�.slurdRau ,c�e Dw,b lay �?ul� ��T <br /> C.rIM1I.M.: <br /> ACCOV/ITINO*MY-, AFD/ FAG <br /> Ps COOS. FE!IMO AMOUPIT RI MT TWO C/1WC ASH RECOMM■Y OAT! MS/MCO RlgUW.7 RI�I IRIVORCR <br /> Pi,h 1LWh c— -Fr.virn 1711 NA371 <br />