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PPLICATION FOR WELL/PUMP PERMIT IVIlVA12C <br /> SA JAQUIN COUNT'e PUBLIC HEALTH SEES pt%vMl ENT LOC L3 <br /> `y ENVIRONMENTAL HEALTH DIVISION x� GLf���E <br /> Copy 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> PERMIT <br /> 4PIRES I 0 DEC 211998 <br /> NBM-REfUN60.6LE PERMIT EXPIRES 1 YEAR FROM BATE ISSUER <br /> ICOmpbta in Trbfiaat'l S:r <br /> APPLICATION I6 IIEM BY MADE TO THE SAN JOAOUIN COUNTY FOR-A PERMIT TO CONSTRUCT ANOMF INSTALL THEM W DESCRIBED.T"""C�IO ICS A COMPLIANCE WRIT SAN <br /> JOAOUI T COUNTY DEVELOPMENT TRIS CHAPTER 9.1116,3 AND THE STANDARDS OF SAN JOAOUIH COUNTY PUBLIC HEALTH SEr1MJCEaF IESRSFCNM Hf, -HE <br /> CRY s�m d lJ PARCEL SIZFJAPNa .. -.._ — <br /> JOB ADDRESSIORCAJPN,a /9� OWQ/ <br /> `-'✓? 57Jry C.(120A IO� ewlc.r✓i CrPC�51 ADOREsa - e� //r !lR 9uG off-/A'27 _PIwNE a.s/o-b SJ-�/T0o <br /> O ER'S NAME C/ C <br /> ADDRESS Ucg PHONEi <br /> CONTRACTOR 6/00 a�e1 and <br /> SIMCOMMCTORII)e Q�'�Zj'T AJOL In' �' rn �) AmREsa S b1rM,P 1 ('.11 2,a ZZ LicE!'S7•/7768/ FrgNEE 107-8J3.3i <br /> v�1 <br /> p, pl MONITORING WELLF ❑ OTHER <br /> TYPE OF WELt1PUMP. IO NEW WELL ❑ REPACEMENT WELL <br /> ��11 El[I <br /> ❑ WELL SYSTEM REPAIR ❑ CIIOBSLONNECIT/REPAIR ❑ VAPOR EXTRACTION WELL F ✓ <br /> ly/A [IN.11 Amp.lr H.P. OEM"PUMP SETH/G FT. FRET WATER LEVEL O <br /> [TYPE OE PIMPI ❑ OUT-0FS'ER=E WELL ❑ GEOPHYSICAL WELL/ ❑ BOIL BORING B <br /> ❑OESTFUCTION: <br /> INTENDED USE <br /> CONSTRUCTION 6PECIFICAMNa 3 A <br /> TYPE Of WELL <br /> ❑ O <br /> INDUSTRIAL ❑6� OPEN BOTTOM DIA.OF WELL EXCAVATION /Os/y 'r DIA.OF CONDUCTOR CASINO 7 • <br /> ❑ DOMESTgRuvATE EIN GRAVEL PAC%/SIZE (O TYPE OF CASMOISTEELJ d C� �o SPECKgDIA.OF ATION L CAMS R <br /> ❑ PVBUCRAVNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL < E <br /> /AG ❑OTHER GROUT SEAL INSTALLED <br /> fly-ii IIP r OROUT BMrrO NAME IUM7L Ce r LAJL <br /> ❑ IPJBGATq N GROUT SEAL PUMPED: 0 Yr 11N' CONCRETE PEDESTAL BV ORI FR:®Yr OF. S <br /> ® MONITORING <br /> iao' s <br /> APPROXI TERING LOCKING CHESTER BO%I6TOVE PP <br /> PPOPoSFD CON6TRlK:TIONIDRILUNO METHOD: MUD ROTARY <br /> AIB ROTARY AUGER CABLE OTHER <br /> mmipgERTIFY THAT I HAVE PREPANO THIS APPLICATION ANO THAT THE WAP(WILL HF DONE IN ACCORDANCE'MTH BAN JOAOVIN CAVITY OEOINANCES.STATETHE ANO RULES ANO <br /> ON3 OF THE SAN JOAOUIN COVITTY. HOME OWNER OR UCEN6ED AOENT'8 SIGNATURE CE{RIFIE6 THE 1 CERTIFY THAT IN THE PNORMMICE OF THE MYATU EOR WHICH <br /> T IB ISSUED.I BIIALL NOT EMR.OY PERSONS SUBJECT TO WORKMAN'!COMPENIATIOM IAWa OF CAUMMRgONU, HIRINC OR SUBCONTRACTING MOI>\ATVO CERTIFIES <br /> OWING: "1 CERTIFY THAT IN TINE PERFORMANCE OF THE MroPK EOR WHICH THIS PfPMR IB ISSUED.I Y PRE GoA B Nu ATECT TO R ARE AN'a COMVIOU MT10N UWS OF <br /> 1A: THE APPLICANT MUST EALL it IIOIIRa IM ADVANCE FOR ALL REOUPEO InHSPE/CTW NS(�AT IMSI AMPLETE OM`MHO AT LOWER AREA T'ROVIO�.4� �� \ \ nB. J//'G V-rOrPnLOl� D.I.\�.�Vim,. � ----TlJPLOT PAM IDrnY le BPeHI 6c.1. "leATgN OF HOUSE BfWAOE dBADBAL SYSTEM OM1 PgfVSEDS OF STNETB OR ROA08 NEAREST TO OR BOUNDING THE FflOPRTY. NSION OF SEWAGE DISPOSAL SYSTEMS. <br /> NE OF THE PROPERTY.AMNO OIMENSgNB ANO NORTH p111ECTION. 6. LOCATION OF WELLS WRMN RADIUS OF ONE HUNDRED FIFTY FT. <br /> 3. DIMENSIONED OVTUNFS AND LOCATION OF ALL EXISTING ANO PI10Po6ED ON THE PROPFIRY OR ADJOINING PROPERTY. <br /> STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WA S. <br /> MRp �fa abed. I <br /> FL - <br /> OfPARTMEHT USE ONLY <br /> ApPlltatl n Aee tl BY <br /> DGe Pane Ir.veNan ar DeHe <br /> 6rBrll IMpe[IIM BY <br /> De.Grc,len Lw"e BY Y( If <br /> / It_ <br /> 5� /Y <br /> ACCOUNTING OILY: AIDO FACE <br /> PE COD" FEE INFO AMOUNT RENBTTED CHEC"MAaN REC9VEO BY DATE MMTMI CE REGVEAT HUNIBER INVOICE <br /> 2Ro <br /> PUC.Health Saw.-Enviro.173(1197) <br />