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• APPLICATION FOR WELLIPUMP PERMIT • SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION P 0 BOX 388, 446 N.SAN JOAQUIN ST.,STOCKTON,CA 96201388 (209) 4683420 NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED ICBmplate In TrFlkml APPLICATION 18 NEW BY MADE TO THE SNI MAGIAN COUNTY FOR A PERMIT TO CONSTRUCT ANIW R INSTALL THE WONT DESCRIBED.THIS APPLICATION 16 MADE IN COMPLIANCE WIIN BAN JOAQUIN COUNTYDEWLOPMENT TITLE,CHAPTER 9-1116.3 AM THE STAND/A�DBJPJF.."AWINCITYCOU JJoe ADDREeBDR aPNI S.e+W +�mNry� CED.ENMNMFNTAL HEALTH DMBON. y PARcn mzEUPxI 2 A CF'(E,J OWNER'S NAME Department of Defense AMRW8 Lathrop, CA FMW 1202)96z-41,9 CONTRACTOR Environmental Science & Engineering, ALU& , Lathrop, CA Ml 658022 L2L09,) 982-0176 SUBCONTRACTOR Layne-Western ( prt,�l.ER� ADDRESS Woodland, CA UCI 51001 662-2825 TVFEOF WEWWIMP: ❑NEWN'ELL ❑REPLAC'FMENT WELL NH MONNOMNO WELL I MWC-1 MWC—OTHER ❑INSTALLATION ❑WELL SYSTEM REPAM ❑CroeS.C...ECT REPAIR 3 ❑VAPOR EXTRACT..WELL I J None 11 H—13 IwW N.P. YEPTHPUMFWT_FT. FIR" LEVFl p WYH OF wMN ❑OUT OF W..F WELL ❑OE.PNYS,CAl WELL I ❑ BOR BORNO p INTENDED ME TYPE OF WELL CONSTRUCTION SPECIFICATIONS A ❑INDwPw. ❑OPENBOTTOM NA.OF WELL EXCAVATION 1011 ON.OF CONDUCTOR CAMW --- O ❑COMESTICINBVATE 13MA LPACKIBNNE B2 Sand TYPEOFCASNISTFE1 PVC DIA.OF WELL CASING p ❑PUSUCRAU.CIPAL ❑MUTH DEPTH OF GROUT SEAL 10, SPECIFICATION Schedule 40 P C p ❑IRAMANINUA. ❑OTHER STOW REALINSTAUED BY La Western GMUT BRAHO NAME T e 1�Fp I �.and E XH..N.RNO I OPoUT SEAL RIMRO:QY=)MMe CONCRETEPEDFSTALWORl1EL 11Y. U.. emepr APFIOX.DEPTH 251-35 LOCKINICHEBTERWXATTOWNPE Yes S PROPOSED CONSTRUCTION.RWNG MUMS: MUD ROTARY AIR ROTARY AMER XX CARIE OTHER I HERBY CERTIFY THAT I HAVE PREPARED THIS ARLCATON AND THAT THE WONL WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OMIMANCE8,STATE LAWe,AND RULES AND MGUTATIONB OF THE BAN JOAOUIN COUNTY.HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIER THE FOLLOWING:'1 CERTIFY THAT IN THE PENOMANCE OF THF YAW MA YMIH THIS PERMIT IB ISSUED,I SMALL NOT EMPLOY HAWN8 SUBJECT TO WORKMAN'S COMPENSAYON LAWS OF CALIFORNIA,'CONTRACTOR'S MONO OR SUB{ORTP IND SIONATUR CEWINFB THE FOLLOWING: 'I CERTIFY THAT IN THE HPFORMANCE OF THE WOW FOR WHICH THIS HRMR IB ISSUED,1 SHALL EMPLOY HRWNS SUBJECT TO WON(MN1'S COMPLNSAMN LAWS OF CALIFORNIA'^THE AAPRICANT MUST CALL M M ADVANCE MR ALL REQUIRED INSPMMNS AT 1E0S1 AMJ.¢B.COMPIETE DMWtMG AT LOMA AREA FROMM eIE•.eX f_�- Ty. -�"�ul. TnI. Geologist ws 12/9/94 s for Layne Western PLOT PUN(D—w ReNN ROI. 'm 350 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE P ORRTY. A. LOCATION OF HOUSE SEWAGE DISPOBA SYSTEM OR PROPOSED 2.OUTLINE OF THE PROPEM,GINNG OPMENMONS AND,OWN DMCT.N. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3.DIMENSIONED ONTUNFS AND LOCATION OF ALL EXISTING AND PI10PORD 6,LOCAMM OF WELLS WITHIN RAMUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIO&DRVFWAYS,AND WALKS. ON THE NORRTY OR AUJOIINING R.HRTY. It �F-_STr-EtT N k G- 5Trct '. Q1R$wZ BASIN L �_Z-M,nlc_2 T IMw 5 — _. .. PEryt 6'R EY�Fzt DEPARTMENT USE ONLY C C o,eln I..F<ne.By �n• ,,A D.I. N,nR BUF�LIee Br wI. D..u,e,ien R.P..nm,BY DIR C.—I.: MI I acAtg.W 15�; I In IA1 C.,7. 4 'YA V)c 3 ac SIS o UNNNO ONLY: AID' FACl H CODES FRESNO AMOUNT RAIITTED CHECKIAMN RECUWD BY DATE P9BATNNINCE REQUFIT NLIM091 INVOICE "a.Cto V I V �h� 711 bx ad