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APPLICAI ION OR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICE <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P. .BOX 300,304 EAST WEBER AVENUE,STOCKTON,CA 95201988 <br /> (2091 469 3420 <br /> NON-REFUNDABLE PERMIT [SPIRES I YEAR FROM RATE ISSUER <br /> IC.1np1•N In TIpReIR) <br /> AMMA710M IB Was BY MADE TO"IE BAN IOAOUIN COUNFY FOR A PERMIT TO CONSTRUCT ANnxFP INSTALL THE VA NL DESCRIBED.THIS APPLICATION 19 MADE M COMPLIANCE VATH BAN <br /> "AMIN C011MY DEVELOPMENT TITLE.CHAPTFPO-1115.8 AND THE STANDARDS OF BAN IOAMIN COUOYMBLIC MALFN 91M CFfrOOBge RdullO-120NIC. HE corner <br /> Joe Aoont.eron APNF Ben}. Holt & Pacific Ave c,,Stockton PAICKSUN Iof intersection <br /> Settl . Dry C can ng ea an s SDL7TsPrJ--819 i11eE GA 9/i608-1829 10-652-4500 <br /> owNEFIR NAME / Do Id 1. B[ad Shaw LeVine-Fricke-Recon ADDRESS YL' PHONES <br /> COMMCTOP ACKSBAB LCI PHOMI <br /> Susc.wmcT.R Weeks Drilling L�., AOMrB6ebastopo 11 CA ICC57-177681 MOM W07-823-3184 <br /> TVPE OFmUUTUMP: 13 MW VMLL ElRFAACEMEM WELL B'.l MO Anaol O WELL I(2) ❑OTMR <br /> ❑INSTALLATION ❑WELL BVaTtM REPAIR ❑CROPS CONVECT REPAIR ❑VAMREMMCTFVNWELLI J <br /> ❑Ne.Y�nptlr IIP. IXT"MmE,onjrT. FIPBFWATEPLEVEL D <br /> ITYPE OF MMPI <br /> ❑OUTAFBFPVICE WELL ❑OEOAIVMCAL WELL I ❑ SOINOWNO I <br /> ❑DFIILICTION: <br /> IMFFxOFO USE Yrt OF W COMSIPUCSION BP7ANON. A <br /> ❑MWSTNAL ❑OrtNa."om DM.OF WELL EXCAVATION 22 to 10-inch M,OF CONRUCTOPCAMM 18-inch D <br /> ❑OOMFBTKMaVATE ®OMVEL P.MM.ZE TVROFCAlUMlRTFEI MA.OFV2LEMMNO 12-inch O <br /> ❑MelWiSMNlcmet ❑.m VIN DEPTH or GROUP SEAL[o depth of conductor IRCICATOM cement-bentonite P <br /> ❑RONATIONIAO ❑.THEA OWIR SEAL INSTALLED BY .MUT BRAN.NAME L;FI E <br /> H MONNOMN. OROUTBFNMMAR®Yr OF. CMCPFIMMOTALWO ENwy Vw LIM e <br /> AMbR.OEPTI. LOCBNIO CIIEBIEP W.IIIOVE IE a <br /> MOTSID CONSTPUCTONNWWNO METHOD: MIA MtARYTg AIR PoTAFVAUGER CABLE OTMI` <br /> 1 NENEBY CEFRIFY THAT 1 NAVE PREPARED THIS AR41CA7lON AHO THAT THE MW WILL Of MNE IN ACCORDANCE VAIN BAN MAOUM COUNTY OMINA?R EB.STATE LAWS.AND PUIFS ANO <br /> REGULATION.OF THESAN MAMIN COUNTY.MIME OWMEP OR LCFNBED AGEM'P SIGNATURE CENTIMES ES TM FOLLOWSKI: CERTIFY THAT IN THE FERMFMANCE OF THE MW FOR VaACH <br /> TMS PERMIT IB ISSUED,I04ALL NOT EMPLOY PERSON.SUBACF TO WMWAN'I COMPMEATON LAW.OF CALIFORNIA:CONTRACTORS NON"On.U.CONTMCTINO SIGNATURE CERTIFIES <br /> THE FOLLDWINO: -I Clon"THAI IN THE PM*FUFAWl OF TM WOKK FOR VMKN TNI.RPMR IB IBIUFD.1 SMALL EMPLOY MKW R9 SUBJECT TO WOROMAN'S COMFFNIATION LAW.OF <br /> CALIFORNIA.- THIS AAUOAW MUST CALL 24 NOME IN ADVANCE FOXIL,,UgRM INBPWTM <br /> ON.AT IEI 40MII, COMft EDMNO <br /> VAATLOWEPARAPMVRED. <br /> ela...� `, ` ���•—� / Ta• Site Project Manager Do. 5/29/97 <br /> PLOT MN Rrnv le%1-1-NG- <br /> 1.NAMES OF"Is",OP WADS WAREBT 1D OR BOUNCON THE AOPFRIY. A. LOCATION OF HOUSE..MAOI OI.MSN SYSTEM OR AOMRFD <br /> I.OUTLIVE OF THE MOROTY.OVUM DIMENSIONS AND NORTH OIRECTION, EXPANMON OF SEWAGE DISMBAL B MMS. <br /> 3.OIMENIIOMD OUTLINE.AND LOCATION Or ALL EXISTINO AND AbroRFD S.LOCATION OF WMLB Wn111N RADIUS OF ONE 14UNOND FIFTY R. <br /> eTiNCTURS.INCLURNO COVERED MEAS SIA N A.PATIOS.ORVEWAYS,ANO WAWA. DN THE FMPE:RSY OR ADJOIONO MOHEMY. <br /> Y <br /> p Cleaning Village \}� Q <br /> Parser.0 <br /> Cart Cle.ne. <br /> Mwlo <br /> B MWII <br /> ✓A/CPT <br /> 4 Mw_S <br /> Chevron IIF <br /> GM SIMiOa MW-3 �. B Ei• <br /> b MW3 Mwc p,Cwlr PVFN A PLar�Frt <br /> MW l r <br /> MW-I &FOR 0. suni.. Cr <br /> MW-9 (formerly Reg01 1k 1 <br /> / and Wickland) $4ca6, <br /> MA <br /> Wa SIR% <br /> MW-7 W-I SMAC <br /> Mw-3 MW-la B� <br /> MW.L MW-11 <br /> + + <br /> ._... <br /> s e ne n e rs na naen Gree r er, JTFJgiIIO!RI! ARI! <br /> Court on January 1�, }996, Sectio 1 Paragraph GPEPMTMMI UBt.Ntl <br /> naPIN•IN„A.•Rl.n <br /> a,.a,rpslbn of DNF Am.ILP.aen Br D.I. <br /> De.euen..IroeOlb,er D.1. <br /> remm.,a.: 1 b• <br /> AccO.x T, .rvtr: n1ol race <br /> PFCOVEO PECOD2 FEE.... AMOUNT REATIED CHECKIKMII F 71.11NCI REOUFIT NUMBED INVOICE <br /> O <br />