FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

APPLICATION FOR WEWPUMP PERM1 #` ' SAAQUIN COUNTY PUBLIC HEALTH SE ES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON,CA 95202 (209) 458-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUER {Compton M TTiplieal�l APPLICATION IS 14C RE BY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.TISS APPLICATION IS MADE IN COMPUANCH WITH SAN JOAQUIN COUNTYIDEVELOPMENT TITLE.CHAPTER 9-1115.0 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADORE,mn APN/ So 3 E AS T T Em T H S T R E E T cTY TRACY PARCEL mzvm o 23 5-19-13 OWNER'S NAME C 0 v N T y Ol= S A r3 TO A a V I'lV ' ADDRESS 222 E. WEBER AVE- 6TH FL00R PHONE#(209)463-3910_ SrOC TON; CA 95702 CONTRACTOR F I S C A E Hy 1 R 0 N M E IV T A L ADDRESS 3 99 5 1i E 9 I'S PLACE uco C- 5l- PHONE (109)11x-35}0 VALLE`[ SPAINCrS CA r W 6$3 665 SVS CONTRACTOR ADDRESS S -L 'UCS PHONE TYPE OF WELIJPUMP- ❑ NEW WELL ❑ REPIACEM09 WELL ❑ MONNTOmw WELL NI OTHER, ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL I J ❑New❑Awek N.P. DEPTH PUMP SET FT. FIRST WATER LEVEL O {TYPE OF PUMP/ ❑ OUT-OFBfHVICE WELL © GEOPPIYBICAL WELL/ ❑ SOIL 801aNO B ❑DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION" '4 ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION Z 1 DIA.OF CONDUCTOR CASINO N A O ❑ DOMESTICIPRIVATE ❑GRAYEL PA"Mr1E TYPE OF CASINOISTEEUW'C N A DIA.OF WELL CASINO NA G ❑ 'PUSLICIMUNICIPAL ❑DRIVEN DEPTH OF GROUT SEAL TO T A L 0 E P T 14 SPECIFlCATION N A_ .x ❑ mRIOATIONIAG 1:1OTHER _ OROVr SEAL INSTALLED BY C o N TP,A C,T 0 R GROAT BRAND NAME f ❑ MOHITONNG GROUT SEAL PUMPED: ■Yap On. CONCRETE PEDESTAL BY DRILLER:©Y. ON. S AP PRO X.DEPTH 7-0 FT, LOCKING CHESTER Bcx/sTOVE PIPE NA s' PROPOSED CONBTTNUOTIONMR ILIINO METHOD: MUD ROTARY AIR ROTARY AVOER CABLE OTHER G 0 P R 4(3 SOIL AND GFiOv)4pWATE9 CRAB SAMPLING, / 'SAVA-9:- DAY A$Ar4DONMENT _ I HE-MOY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL Of DONE IN ACCORDANCE WITH BAN JOACMN COUNTY ORDINANCES,STATE LAWS.AND RULES ANO REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED',AGENT-9 SIGNATURE CERTIFIES THE FOLLOWING.'I CERTIFY THAT TN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT ENOMOY PERSONS SUBJECT To WoMWIAY-S COMPENSATION LAWS OF CAUFORMA-' CONTRACTOR'S HIRING OR SUS-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: i'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB MOVED.I SHALL EMPLOY PERSONS SUBJECT To WOM MAN'S COMPEMSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL M HOURS IN ADVANCE FOR ALL REQUIRED INSPBOTIONS AT N2"1 446-3422. COMPLETE DRAWING AT LOWER AREA PTTOVIDED: 9191-d x TRI. I:DwsVL.rANJT' AfrENT D.Ir, la[2919�- I I T o S E 4 R A M A G e PLOT PLAN Iola+•1e$*Wei Se-l. •toy I. NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROIVITY. �. LOCATION OF HOUSE SEWAGE p1APSYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERNI TY.OMNO OIMENSNS AHD NORTH DIRECTION. EXPANSION OF eEWAOE DISPOSAL SYSYSTTEEMS, Z. OIMENSIONED OUTLIVES AND LOCATION OF AtL EXNSTSaO AND PROPOSED 6. LOCATION of WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FF. - STRUCTURES.INCLUDING COVERED AREAE SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. 4 Aj DEPARTMENT USE ONLY - - Applkalbn Aoaelrled BT two MM G#-A hlapaGllan BY.. DNa- Pump WmBY -Date O—InKlhn Imp`ecq;;n^BY j,�{LJ� r'] D�tr• CMInM111a: }/Jr {pY ACCOVNtINO ONLY: AID/ FACS PE CODES FEE INFO AMOUNT RENETTED CHEC"MASN RECEnm BY DATE P9EMTISERVICE NLEOUESr NUMBER INVOICE Pub.Heats Sam!-Enviro.173(m