SITE INFORMATION AND CORRESPONDENCE_CASE 2

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APPLICATION FOR WELL(PUMP PERMIT -- SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES `j ENVIRONMENTAL HEALTH DIVISION P 0 BOX 388,446 N.SAN JOAQUIN ST,STOCKTON,CA 96201-388 12091 468-3420 WON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete In Tripliestal APPLICATION 16 HERE BY MADE TO THE RAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITTLE,CHAPTER y9-11115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOBADORESS/OR�.AAPN/ Z1 Ur`I,� G1�o L�1I.S'�+ ,AAye-nye- CI., ✓gyt'"'m(W PARCEL SIZE/APNI y�y} OWNER'S NAME MCI N�'t(Q% yE1L'F kPl\ SOV3C\ 14t.1lnL-1�ADDRESS LIQ( asf L0.1RS�- d-y*-VIVIL PHONE/L"1 CONTRACTOR Sft'+\'\ F7NV�f0A ivle M aLI T t0o%- l-o rp- ADDRESS 17(O'VC �+'.^I.k#%A;is Rd LIC/5 E)W1 1 ggNE I 20 S-9-L-Lz.2-1 SUBCONTRACTOR-+Qu\�M D,,r;\\%/Lot ADL)REes L'�I4J Ery,r•v . UCO012L-t PHONE 0L�y�- v TL TYPE OF WELI/MIMP: ❑NEW WELL ❑REPLACEMENT WELL VMONITORINO WELL/ J ❑OTHER ❑INSTALLATION ❑WELL SYSTEM REPAIR ❑CROSSCONNECT REPAIR ❑VAPOR EXTRACTION WELL P J ❑N.w❑P-w, N.P. DEPTH PUMP SET—FT. FIRST WATER LEVEL O 1TYPE OF PUMP ❑OUT-OF-SERVICE WELL ❑OEOPIVSICAL WELL/ ❑ ROIL SORING S DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION A 13INWSTRIAL 13 OPEN BOTTOM DIA.OF WELL EXCAVATION O" DIA.OF CONDUCTOR CASINO •N�� O ❑DOMERTICIREVATE ❑GRAVEL PACK/SWE TYPE Of CASINOISTEELMC .-- DIA.Of WELL CASINO Z D 11 Psuc/MUNICIPAL ❑ORIVEN DEPTH OF GROUT SEAL ow, -I T SPECIFICATION SL�\n t R ❑IRRIGATION/AG ❑OTHER GROUT SEAL INSTALLEDD r,hBY�{�1'�k%0 GROUTBRAND NAME BRNAME("LEIA --'%' 4fo R•kE A(MONITJa<J ORING L GROUT SEAL PUMPED: YM ❑N. CONCRETE PEDESTAL BY DPoLLFR:❑Yw AYN, S APPROX.DO" 30 LOCKING CHESTER SOX/STOVE PIPE S PROPOSED CONSTRUCTION/ORILUNO METHOD:MUD ROTARY AIR ROTARY AUGER CABLE OTHER_' I HERESY CERTIFY?HAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE M ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORONAN°S COMPENSATION LAWS OF CALIFORNIA.'CONTRACTOR'S HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT to ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORIOAAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 SOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT 1209))440645/27.COMPLETE DRAWING AT LOWER AREA PROVIDED. E9T1.1 X /k1(= YNt11.U1 Tm._�rjjb r l�Gt /(�,lgngga z I'� D.I. POT PLAN M'—I.S..) � l• 1.NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4.LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPERTY.GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3.DIMENBIONEO OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S.LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT, STRUCTURES,INCLUDING COVE AREAS SUCH AS PATIOS.DRIVEWAYS,AND WAU(B. ON THE PROPERTY OR ADJOINING PROPERTY, rI �JMAIINENANCE I(, ^1 'No" S10RAGE 7 S,RD I n STORAGE I4OF ES n SHED'— 1 E-1-1 ` d 1 �w 4' SEWER 100' , _MST MAT 1 I CENTER 3 MW SCIKXX - SUS PARKING 1�I -JI —EXCAVATION SR-2 1 EDGE OF 5R-3 I C ASPNALI s 2-1/a'GAS 1 ' MHOu OIAE . p T WATERO —I 9 L,J Q M-2 aMIRKY I I / ES LL l� P RKGIIN, J[/�� GAS❑ `-� O17-HE-AL-TI-1-1 SEWCES LOUISE AVENUE GENERALIZED SITE PLAN MANTECA UNIFIED SCHOOL DISTRICT LE-41) 2901 EAST LOUISE aw-34 •GP"MATER MONITORING WELL LATHROP. CALIFORNIA OE►ARTMENT USE G— APpee -A..apt..DY On. `--"�' L, Nr Gr.Vi 11W 11-BY D.L. P—P I-P-1-By D.0 D—V..LnP—.1 BY C.Tm.nH:_�j('ssur-C VI, Ly� ACCOUN?INQ ONLY: AOI FACS PE CODE? FEE INFO OUNT REMITTED CHECKS/CASH CEVED SY DATE PEYAIT/661VICE REQUEST NUMBER INVOICE 2