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' APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES* <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 5881 SOA EAST WEBER AVENUE,STOCKTON.CA 95201588 <br /> (2091 4683420 - <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED <br /> ICBmpM11 In TIIpIke61 <br /> AMICATNIN IB HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBER.THIS APPLICATION 16 MADE W COMPLIANCE MIT BAN <br /> JOAOUIN COUNTY DEVFID%AEM THIS.CHAPTER 91115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. <br /> frontage Rd 100'. f NE corm <br /> JOB ADDRESBNR AMM Ben . Holt & Padf iC Ave. clrYStockton FAMCEL savAPHPf �ntersect <br /> S t[ in r C eaT1 T1e enanC 10-652-4500 <br /> GG pp 1 g 19 owe 5 <br /> OWNER'S LANAE C/O �n�ld �'. Brads118W, eV?ne-fr c e-RECON ADDMBBpryv MFC7446075 446 -18 PMNEI <br /> CONTRACTOR ADDRESS UCI INKINGI <br /> 190 owe Rd <br /> Sue CONTRACTOR G 68 D illing & Tee Cing Inc. yy ADoxee Marty JP.�fA 94R53 LIOfA485165 FXONE SIO-313-5800 <br /> TYPE OF WELL/PUMP: NEW WELL ❑PEMACEMENT WELL 1J' ...NOTING WELL I ❑OTHER <br /> ❑HUFTALLATION ❑WELL BYBTEM REPAIR ❑CEASE-CONNECT AFFAIR ❑VAM R EXTRACTION WELL/ .l <br /> ❑Non D Not. HP. DEPfN.EMP SET----FT. Hear WATER UWE 0 <br /> OYPE OF%EM% <br /> ❑OIfL-OFSERVICF WELL 0OEOPNV61CK WfLLI ❑ FOIL BONN. B <br /> ❑DESTRUCTION: <br /> MlE..ED USEr OF CONi}RUCT OX EFECIfICATION6 A <br /> 11 INDUSTRIAL X❑yOMNB.TTOM INA.OF WELL EXCAVATION 12-inch CIA,OF CONDUCTOR CASING D <br /> ❑OOMESTMRRIVATE SOMVEL PMgm3F TYPEOFCAMIKUSTEEINVC pVC & steel OIA.OFWELLCAGNO 4-inch 0 <br /> D MIBuc.u.amxAL DDRIVEN DEPTH OF GROUT SEAL 45 ft wEcwicATION cement-hentonito R <br /> "DID INOOATIOWAO DOTTIER .ROUT SEAL INETNLFD BY driller .ROVE BRAND NAM E <br /> a MONITORING ...T SEAL MIM..:LAV. OM <br /> No CONCRETE Of6TAL BY DRILLER:D Y. 11. 3 <br /> APPROX.SMITH LOCKING CHESTER GQXQHRVE%M R <br /> T MIM CONSTRUCTIONnWWNO METHOD: MUD ROTARY AIR MTARY____,Z AUGER_ _CABLE OTHER <br /> I HMSY CERTIFY THAT 1 HAVE PREPARED THIS AP%1CATION AND THAT THE MUM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCM,STATE LAWS AND RULES AND <br /> MODUTIONB OF THE BAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AOENT'B SIGNATURE CERTIFIES THE FOLLOVARM'I CERTIFY THAT W THE MRfORMANCE OF THE WOW EOR MICH <br /> THIS MNAIT IB ISSUED,I$HALL NOT EMMOY MRBONS SUBJECT TO WORKMAN'[COMMISATNN LAWS OF CMM MA.'CONTRACTOR'S HIRING OR WSLONTMCTIHO SIGNATURE CERTIFIES <br /> THE FOLLOWING: -1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW.FOR VMICH THIS MRM.16 ISSUED.I MIALL EDITION MRWHB SUBJECT TO WORKMAN'S COMMrI[ATNN LAWS OF <br /> CALIFORNIA.- <br /> NA WHIM,NIA.- TNS APCANT MUST CAM 24 ADVANCE FOR AIL REGUAW INSI[C HONG AT 020.14"NMMIO <br /> 21.COMM ME OAAMK1 AT LOWER AREA VKHO. <br /> Elpc.r `� --�� �"- Tnl. Site Project Manager Dot. 5/28/97 <br /> i <br /> MOT MM mrKI U M.1w BeW_ Ie <br /> 1.NAMES OF STREETS FF MADS GIVING <br /> DIM TOOK AND NOR THE PRCTION. A. LOCATION N OF SEWAGE <br /> EED"ImNAGE m SYSTE SYSTEM OR M10POSED <br /> 3.OUWNXOFD THE OPMMRN. LOCATION <br /> FALL AND NGANDFROME EXPANSION FBf UG mePoBALSOFON <br /> ].STRUCTURES, <br /> INCLUDING <br /> AND COVERED <br /> OFALLEXIST sPATOANDMgPoeEO [.LOCATION WITHIN RADIUSOFONE NVNmGD fIFIY p. <br /> 6TflVLTUMe,INCLUOINO COVEMO AMAB BUCN\\A�S�yP�A�Tg�B.'DRIVEWAYS,AM WAIKB. ON THE PROMRTY OR ADJOINING MOMRFY. <br /> Jj 01.✓ CICMInB WIG [ ..•�� <br /> CA.Gleam. sod <br /> �\ Cim Cleonencst <br /> . <br /> a <br /> MW 10� <br /> D7yYD MWII n •�acPT <br /> // 3R MWS <br /> I <br /> o' 'o <br /> / M <br /> Chevron RE C. <br /> G.$mllOn MW.] <br /> MW3 MW4 Yp'coctVFlL�A 8 P <br /> b MLN-7 l l� <br /> Mw.l Enron Gu Station 'VO�Llt et' <br /> NINA <br /> < o1 <br /> BadWikiand) V S7EJr�TM`' <br /> Wd <br /> W' * Sixw <br /> mw-7 W.1 <br /> MWJ MWdD Bow <br /> MW.E MW-II / <br /> *SDCDs defined in the First Final Consent Decree pp��FPMTdUdVT..tONLand Referenced to Special Master, filed with the <br /> MITCourt on 3a r 8, 1996, Section IV, Paragraph 0' <br /> NrIm.IHO A.awm /7l R.I. N.. <br /> ar D.I. Mom ImP.Onn BY DM. <br /> 0-11-.0-poo MO av Rn. <br /> mm f PINI L; L/ lig <br /> 19 1 y m7m,11- - <br /> Acco.NTmD Gmv: Alla FAC. <br /> PE COD. FEE INTO WITTED CHECKIKA6H RECOVED BY DATE FDG <br /> AITIEERM01 REQUEST NEARER INVOICE <br /> 29D --'6-13�3 <br />