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4 L 7 - <br /> APPLICATION <br /> -APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICRRI'11u in TTP41111) . <br /> AP/11CA7ION IR IGEAE BY MADE TO PIE EAN JOAOUM CDUNTY FOR A PEFPAT TO CONSTRUCT ANo/OR INSTALL THF VMW oFSCRIREO.T105 APPLICATION IS MADE W COMPLIANCE YYRV BAN <br /> JOAOUIN COUEFFY OFVELOPMFN1 TrrLE,CHAPTER 8-1116.3 AND THE STANDAADB OF RAN JOAOLRN COUNTY PUBLIC HEALTH SERVICED.FNVSYONMENTAL HEALTH DIVIMH. <br /> JDB ADORE93/DR APNr 17 4 0 0 1i e!112 n y R d cnY Tracy_ rnncEt HITFJAr+IP <br /> OWNFWB NAME Rankin Ag Service ADDM8916850 S.Tracy Blvd PHONE r <br /> CONTRACTOR Freitas Electric , Inc. ADOrHj.0.Bx 16 Banta „,{+53962 ,0„F,835-2814 <br /> "CONTRACTOR E <br /> Iy ADDRESS �-T UCS PHONE IF <br /> TYPE of wEUJPUMP. LJ HEW WELL ❑REPLACEMENT WFLt ❑MOWrMNO WELL I U OTHER <br /> ❑..M".--I1M-LATION ❑WELL SYSTEM REPAIR [jCR088CONNECT REPMN Q VAFOR ExTRACTmH,WELL A J <br /> tj <br /> Sub Hew LJ R. MP. 1— 1 /2 of"H PUMP act 8 0 FT, FIRST WATER LEVEt 2 4 -.. O <br /> (TYPE OF POMPI �-1 T� <br /> Ll OUT-oF-6ERVICE WELL C1OEOFHYGICAL WELL F Q BOIL BORING H <br /> 11 DESTRUCTION: <br /> INTMD USE TTPE OF WELL CONSTRUCTIOR U+ECIFICADONS A <br /> ❑INDUSTRIAL ❑OPEN BOTTOM GIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CA81NG o <br /> ❑DOMEST1CS"VATE ❑GRAVEL PACKIIIIL! TYPE OF CABiN016t EELIPVC GIA.or WELL CASINO D <br /> ❑PIISUC/MUNICIPAL ❑DRIVEN DEFT"OF OTIOUT SEAL SPECIFICATION R <br /> ❑IRRICIATIONJAO ❑OTHER GROUT SEM.INSTALLED BY OROUT BRAND HAW. <br /> E <br /> Cl MONTOWNI ,How SEAL PDMPED:❑Yw ❑Ne CONCRETE T'EDESTAL RY OIVLLFR;❑Yw ON. S �r�y <br /> APPROX.DEPTH 290 LOCIRM CHESTFR SOX/STOVE RPE <br /> $ 01 <br /> PROPOSED CONSTFIUCTlONfDRFLU110 METHOD:MVO ROTARY AIR ROTARY AUGER CABLE OTHER (` <br /> 1 NE ,RY CETTITFY THAT I IIAVE PREPARED THIS AFFUCATION ANI THAT THE WQW VALL HE DONE M ACCORDANCE MATH SAH JOAOUIM COUNTY OFORIAHCES.STATE LAW*.AND-"I AND <br /> REOULATIONS OF THE SALT JOAQUIN COUNTY, HOME OWWO OR LICENSED AGENT'S GN <br /> SKATURE CERTIFIES THE FOLLWTNO <br /> O :I CERTIFY THAT SG THE PERFORMANCE OF THE WON(FOR WHICH <br /> T1418PERMIT re ISHVEO,1 SHALL HOT EMPLOY PERSONS SUBJECT TO WaPWAAN'S COMMIIATIOF/LAWS OF CALWDF"A_•CONTRACTOR'S HRSNO OR BUBLONTPACTM SRONATURE CERTIFIES <br /> TIIE FOLLOMANO: -1 CERTIFY THAT IN THE PERFORMANCE of THE WOTTS FOR WHICH 1"m PERMIT IS ISBUEO,'SHALL EMPLOY FERMONS SLIR.IECT TO WORI7AAN•1 COMPENSATION LAWS OF <br /> CALFORIIIA.- THE Mol&f AMT CALL 2,4 HOURS W ADVANCE FOR ALL REVUNED 7M{/�{}J� MR1 AT 420M40*442a.COUPLETS DMWMfg <br /> O AT LOWER AREA PVTDFFM o p� <br /> Rb Pax /p Tltl. !1 i{ ^_ D— 7 <br /> PLOT <br /> ►LAN p...v Ie D.wN eat. 'b <br /> I. HARASS OF STREETS OR ROADS WARE"TO OR ROUNOIN <br /> O THF PROPERTY. 4. LOCATION OF HOUSE SEWAGE O(R OIIAL SYSTEM OR PROPOSED <br /> T. OUTLME OF THE PRDPERTV,OWN"OIMENSgNR AND NORTH OIRECTION. EXPAHIION OF SEWAGE tMRPOSAL SYSTEMS. <br /> 3. DU.IENMONED OIRVNFE AAO LOCATION OF ALL EMIFTRM AND PROPOSED ■.LDCATION OF WELLS WTINN NADONS OF DW HUNDRED FIFTY FT, i <br /> 81'"JCTUREI,INCLVV*M COVEME)AEEAS SUCH AE PATNA.DRIVEWAYS,AND WALF-. DN THE PROPERTY OR ADJOWRIO PROPERTY. / <br /> .: .. < ...... i. .' ... <br /> JUL 13 1998 <br /> SAN JUA 'hi Lti <br /> PURLIC HEAI.IH SERVECES <br /> -ENVIRONMENTAL HALTH DMS!,11" <br /> 1 <br /> D"AATMENT URE ONLY I <br /> APPIbwHw.Aa,o,P,l BF bM/• .4r � 7 <br /> O.w.l Ir..PaaIbNl RT F�.mP IINP..IIe..Ry t / lam— Ow.l%T._,'� <br /> Vh\nw11M lnvvvlbn BT f DVA <br /> ADCDUN rINO oNY: AIOF FAC/ <br /> PE coots FEE Iwo AMOUNT RpATTTFD C/NCK/ ASN RKcovm BY DATE PERWT/SDIVICE REGLIES T Nll.}B GR INVOICE <br />