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CONTRACTOR Gregg Rrilling Pacheco CA ADDRESS IJC# 485165 PHONE #(510)603-271 <br />0 OPEN BOTTOM <br />0 GRAVEL PACK/SIZE <br />0 DRIVEN <br />0 OTHER <br />TYPE OF WELL <br />2/12 <br />PROPOSED CONSTRUCTION/DPRUNG METHOD: MUD ROTARY AIR ROTARY AUGER X CABLE OTHER <br />FT1-13ER.T ST Re ET <br />30' <br />SCALC <br />Date Lg- — - Area 9 `f <br />Date <br />Date <br />AID# FAC# ACCOUNTING ONLY: <br />N. Filbert Street CITY Stockton <br />OWNER'S NAME <br />PARCEL /rANPN# AP P . 5 ACR. <br />ba-rf (....44PLICILDREss f4 j. -5±V"-:—'• PHONE() S <br />5.s_i <br />_J <br />JOB ADDRESS/OR APN# <br />SUB CONTRACTOR <br />TYPE OF WELLJPUMP: INEW WELL <br />12 INSTALLATION <br />0 New 0 Repair <br />(TYPE OF PUMP) <br />0 DESTRUCTION: <br />ADDRESS <br />El MONITORING WELL /4W D— IS-10 <br />CROSS-CONNECT REPAIR <br />DEPTH PUMP SET FT. <br />GEOPHYSICAL WELL # <br />iJC# PHONE # <br />OTHER <br />••• 0 VAPOR EXTRACTION WELL # 70' BGS <br />FIRST WATER LEVEL ' <br />SOIL BORING <br />0 <br />INTENDED USE <br />INDUSTRIAL <br />DOMESTIC/PRIVATE <br />PUBLIC/MUNICIPAL <br />IRRIGATION/AG <br />MONITORING <br />APPROX. DEPTH <br />CONSTRUCTION SPECIFICATIONS <br />DIA. OF WELL EXCAVATION 8 N <br />TYPE OF CASING/STEELJPVC PVC <br />DEPTH OF GROUT SEAL 63' <br />GROUT SEAL INSTALLED BY Gregg Drilling <br />GROUT SEAL PUMPED: El Yes 0 No <br />LOCKING CHESTER BOX/STOVE PIPE <br />A <br />DIA. OF CONDUCTOR CASING <br />DIA. OF WELL CASING 2" <br />SPECIFICATION <br />GROUT BRAND NAME <br />CONCRETE PEDESTAL BY DRILLER: M Yes 0 No <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND <br />REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WOFV( FOR WHICH <br />THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES <br />THE FOLLOWING: " I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA. EHE APPLJCA T_ MU CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT 1209145S-3423. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br />Signetk R65410 <br />4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br />ON THE PROPERTY OR ADJOINING PROPERTY. <br />Date Pump Inspt By <br />Application Accepted By <br />Grout Inspection By <br />Destruction Inspection By <br />Comments: <br />I PE CODES FEE INFO AMOUNT REMITTED CHECK/1/CASH RECEIVED BY DATE PERMIT/SERVICE REQUEST NUMBER INVOICE <br />7)1 ;/- .)-. 3 <br />-, - <br />Title Hyd T-ngpnl ng i qf <br />PLOT PLAN (Draw to Scale) Scale to <br />NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. <br />OUTLINE OF THE PROPERTY, GIVING DIMENSIONS AND NORTH DIRECTION. <br />DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED <br />STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. <br />Date 1-31-95 v\ <br />REPLACEMENT WELL <br />WELL SYSTEM REPAIR <br />H.P. <br />0 OUT-OF-SERVICE WELL