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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> 17 St7h J K•R FUNDABLE PERM "PINES 1 YEAR FROM DATE ISSUED <br /> ICSIIIpMES M TTIpReBIB► <br /> APPLICATION IS IERE BY MADE TO THE BAN JOAOUN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIIED.7196 APPLICATION IS MADE IN COMPLIANCE WITH SAN <br /> JOAOUN COUNTY DEVELOPMENT TITLE,CHAPTER 8•1}15,3 AND THE efANDA1IDB OF MAN JOAWJN 1,17NTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION, <br /> JOB AODPEBSMR ASN+ BETHANY RD '/� MI. E. OF B Y R O N CITY j Y Y TRACY PARCEL SRE/APNR <br /> OWNEq'SNAME EVERETT RANKINS ADDRESS 16850 TRACY BLVD. TRACY PHONE, 836-1638 <br /> CONTRACTOR HENNINGS BRO5. DRILLING CO., INC. ADDRESS 3525 PELANDALE MOD uc, 290813 PHONE, 545-1185--+{ <br /> SUBCONTRACTOR ADDRESS UC, %BORE, V <br /> ffiE OF wtuipuMP. ®NEW WFLL ❑REPLACEMENT WELL ❑MONITORING WELL S ❑OTHER `yJ <br /> ❑INSTALLATION ❑WELL SVSTEM REPARL ❑CHOBB-CONNECT REPAIR ❑VAPOR EXTRACTION WELL I J ,'•(}L��J <br /> El El H.P. DEPTH PUMP BET^_FT. FIRST WATER LEVEL p k� <br /> R VPE OF PUMP) <br /> ❑OVTdF-SERVICE WELL ❑GEOPHYSICAL WELL, ❑ BORBOWIAO B-` <br /> ❑OEETRUCT ION: <br /> INT DED USE TYPHI OP CONSYMM IOM SPECIFICATIONS .1 A <br /> ❑INDUSTEN RIAL ❑OPBOTTOM DIA.OF WELL EXCAVATION 1�2)11 b1A.OF CONDUCTOq CASINO <br /> ROOMESTMC VVATE �ORAVEL PACK=ZF TVP[OF CASNIOISTEELRVC PVC DIA.OF WELL CASINO— 611 O <br /> ❑-T PUNUCIMUHICIPAL ElONVEN DEPT"OF OROUT SEAL 100 1 SPECIFICATION BENTONITE <br /> 0 MMOATIONMO ❑OTHER GROUT SEAL INBrALLED BY HENNINGS orouT BMHb NAME v, <br /> ❑MONITORNO 2 0 O L GROUT SEAL PIMPEOv 91 Y.. ❑N. CONCRETE PEDESTALSY DWLLER;❑y.. A3w* s <br /> APPROW.DEPTH L LOCKING CHESTER BOXIVIOVE RPE g <br /> PROPOSKU CONSTRUCTPONIDISLIRIO METHOD! MUD ROTARY X X AIR ROTARY AUGER CABLE OTHER <br /> I HE-"Y CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JDAGUN COUNTY ORIINANCES,STATE LAWS.AND RULES AND <br /> REGUTATIDNM OF THE BAN JOAOUW COUNTY.NOME OWNER OR LICENSED AOENT'S SIGNATURE CERTIFIES TM FOLLOVMQr'1 CERTIFY THAT N W <br /> THE PERFORMANCE OF THE ORK FOR WHICH V } <br /> THIS PERMIT IS IMBUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAMS OF CALIFOTNIA.-CONTRACTOR'S HIRING OR SUN CONTRACTING SIGNATURE CERTIFIES <br /> TM FoUOWNG! '1 CERTIFY THAT N TOE PEWDR MANCE OF THE V40M FOR WHICH THIS PERMIT IS IISUEO,1 SHALL EMPLOY PERRONE SUBJECT TO WORI(MAM'S CDMVj NMT1OI1 LAWS W <br /> CALMORMA.' THE APPLICANT MWT CALL 24 HOUR&IN ADVAMCL POR ALL MOWID INBrtLTION,ST RSMR 40EJ4ES.COMPLETE DMWNO AT LOWER AREA PROVDFO. <br /> June 9, 1998 <br /> EI.,wX atrrns.J♦.�It- 43ru�C��v����.-�,l-♦C. R. � D.L. <br /> PLOT PIAN 10—1.S.ww S—.—,I. <br /> I,NAMES OF STREETS OR ROADS NEAREST TO OR BOUNCING THE PROPERTY- 4. LOCATION OF HOUSE IFWAGE DISPOSAL SYSTEM OR PROTOSED <br /> i.OUTLINE OF TNT PROPERTY.DIVING OIMENON"AND NORTH DIRECTION, EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br /> a.OIMENdONED OUTLINES AND LOCATION OF ALL EXISTNO AND PROPOSED I.LOCATION OF WELLS WITHIII RADIUS OF ONE HUNDRED FRTY FT. <br /> STRUCTWEM,BVCLUDBEG COVEN IDEAS SUCH AM PATIOM,DRIVEWAYS.AND WALKS. ON THE PROPERTY OR AMMW 40 PROFHTTY. <br /> Ids rI <br /> ..� <br /> .62, <br /> / K h <br /> f/ I �s-,4 �►T- <br /> Lj+ Cl <br /> fF <br /> _ I VTR : <br /> r <br /> PAYMENT' <br /> I REGE!VE► <br /> # tf `k1 1998 <br /> S. <br /> I _.SAN JOAUUIN COUNTY . <br /> PLJBLJC HEALTH SERVII-5 <br /> ENVIRONMENTALP.F_AI.'!F <br /> DEPNITMErT LHS ONLY ^ <br /> C,4 <br /> MI <br /> APPM.Ih-A..wII.r BY bn. C Ma. <br /> G.. Rrw...11.n IT --0Ef:-X-/2-`A�-� <br /> ,y[�� P—P Iryp..O.n By D.1. <br /> D..R.uolsn h.IlRell.n B DH. <br /> ce.....e.A.r IQ .TA i i� i_ fG:Ik�;T' — '?I-er} ,.+7L-Q ' T%L '� r'.L 6 .f _ 2-9B <br /> ACCOUNRNQ ONLY: AIDE FAC/ <br /> PE COOLS FEE TWO AMOUNT RBMITTED fE ICASH RECOVED IV GATE PIPANTISOMCE REQUEST NLAM ER NIVOICE <br /> o '1 <br />