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c, 7 0. APPLICATION FOR WELLIPUMP PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON,CA 95202 (209)468-3420 MON-REFUNDABLE PERMIT EXPIRES 1 YEAR FADN DATE ISSUED IcampimiF In TrIpR1a1F) . APFUCATXIN IR HIRE BY MAOI TO THE BAH JGAOLRN COUNTY FOR A PGRMTT TO CONSTRUCT ANOMI1 INSTALL THE WOW DESCRIBED.TIRE AFT%`CAT10N t8 MADE W COMPLIANCE VM;I BAN JOAQUIN COUNrV DEVELOPMENT TrTLE,CHAPTER 8-1115.3 AND THE STANbARO9 OF RAN JOAOUIN COUNTY PUBLIC HFALT14 SERVICE a.FNVFIONMENTAL HEALTH DMSON. JOB ADDHEBBRIR APNf 17_400 B e r}L a n y R cl CRY "Ur a c y rAROEt SIZEfAT,'N OWNFABNAME Ra nkia Ag Service ADO#W8816850 S.Tracy Blvd COLDRAcrOR Freitas Electric , Inc. ADDRFF.F.O.Bx 16 Banta I, , 53962 P..E,835-2814 PUB COMMCTOR 1- 11---TI ADOM" UCI PHONE F TYPE Or WEgjymF' 0 NEW VrELL 0 REPLACEMENT WRL ❑MONITOINO V,Ell J ❑ R -T OTHE [IMSTAILATMN 11YVELL SYSTEM REPAIR ❑CRO88COMfECT REPAW Q VAA7R EXIRACTOHYAu F J .rJ u b ]NF.. R�pYr N.P. 1- 1/2 DEPTH RIMPBEr 80 FT. FIRST WATER LEVEL 24 p (TYPE Or MMM r� ❑ OUT-0F-SERVICE WELL ❑OEOHIYSACAL WELL I Q SOIL BOWNG g 11 OES'TRLFCTp N: TINTENDED UFE TYPE OE WELL CONSTRUCTION FPECIFTCATIONF A Ll*MUSTIAL ❑omN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONOUCTOR CASINO D ❑DOMESTICTR IVATE r❑ORAWL PACXIMZE TYPE OF CASMOttltft1 D-A.OF WRL CAMW p ❑PUBIIC/MUMCIPAL U DRIVEN OEPTH OF GROUT SEAL SPECIFICATION q _ ❑ rIpOATIONfAO ❑OTNFR GROUT SEAL INSTALLED BY ORDUi eTUND HAMF. E i ❑ MONROIND GROUT SEAL P1MPE0:❑Yw ❑Ne CONCISTE PEDESTAL SY MILLER:❑Vw ❑N. S _I Apmox.DEPTH 290 LOCXRTO CHESTFR SOXIBTOVE RPE a PROPOFFD CONSTRUCTIDIEX IJXG METHOD: MUU IOTAHY AIR ROTARY AUGER CABLE OTHER 1 HERESY CEFITTFI'THAT I HAVE PREPARED TNIR AP'1CATION AMT THAT THE WDA(WALL IF OONE M ACCGFUA14CE VdTH 6AH JOAUKVN COUNTY OR DTHANCFS.BT ATE LAWS.AHD RULES ANO IIEM"TIONS DF THE SAN JOAQUIN COUNTY. HOW OWMEA OR LICENSED AGENT'S.1—ATURE CERTIFIES THE FOLLOWSIO:1 CERTIFY THAT IN THE PER FOWANCE Of TFIE NOH(FOR WHKR 1118 PERMIT IB I81PUED.1 BIiALL NOT EMPLOY PERMIN8 RLM-ECT TO WORWAN'F COMPENSATION I AY OF CALIFORNIA--CONTRACTOR'S OPINO OR SUBCONTRACTING SIGNATURE CERTGrr8 THE FOLLOYGNO: .I CERTIFY THAT M THE PERFONWANCE OF THE YYOAL FOR VATICH THIS PEM.ITT M 16"IJ,I MIALL EMPLOY PERSONS ttIeJFCT TO WORXMAN'S COAEPENSATIDN LAWS OF CALIFORaA,- THE Mf MLFST CALL 2,4/b URS M ADVANCE FOR ALL REOIAn[71 (M/F.'].T�wwF AT I"111 Atl-1421.COMFLTE DIA"NO AT LOWER AREA PROVpfD. �j n ROT RAN R}�.v le SArN Ba.l. 'b 1. NAAAEe OF BTRFFTB OR ROADF NEAREST TO OR BOUNDING THE PROPEFTTY, 4, LOCATION OF HOUSE SEWAGE V(S OSAL SYSTFM OR POOM5ED Z, OUTLINE OF THE PROPERTY,01%4113 DS.U~N8 AND NORTH OFIECTION. EXPANIND"OF SEWAGE OIaPORAL SYSTEIAa. Z DIMENSIONED OUTUNFE A LOCATION OF ALL EXISTR)AHD PROPOSED ■.LOCATION OF wrLLS vmm"RADIUS OF ame HIJNDRFO FIrTV FT. BTRLFCTUREe,MLVUREG COVFMD AFFAS SUCH AS rATN".DFSVEWAY8,AND WALXB. ON THE PROPERTY On ADJOINING PROPERTY. / ......;. . : ... . PAS"�I EJ WJ JUL 13 1998 SAN JUAC]u;M CUL:hil„ PUBLIC HEALER SERVfGES ENVIRONMENTAL HEALTH DiViSfUN DEPAATMEJIT USE ONLT ApplbnMn AA.gIr,I er bN� I Mr� O,— elA.+PY R.mr Mw Puede..By U�.v IHMlen I.wFeolbn BY blll AccouNHNo omr: AIDE EACF R cooES FEE Iwo AMOUNT RSAaTTED CHECXE ASN RECBVM BY DATE POVATT14MNCE REOUESr NL-409l INVOICE '�ao c �I13!rB sKo a�