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TYPE OF WELL/PUMP: El NEW WELL <br />El INSTALLATION <br />0 New 0 Repair <br />(TYPE OF PUMP) <br />0 REPLACEMENT WELL <br /> <br />O MONITORING WELL <br />El WELL SYSTEM REPAIR <br /> <br />O CROSS-CONNECT REPAIR <br />H.P. DEPTH PUMP SET Fr. <br />0 OUT-OF-SERVICE WELL <br /> <br />O GEOPHYSICAL WELL # <br />OTHER <br /> Y6,5 <br />El VAPOR EXTRACTION WELL <br />FIRST WATER LEVEL <br />SOIL BORING <br /> Date <br />eeht-c444A2-.--0-5 4-/ zeiGl/ r <br />Destruction Inspection By <br />Comments: oyvIc7(_, <br />Wgd <br />JUN 2 1 1995 <br />APPLICATION FOR WELLIPUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P 0 BOX 388, 445 N. SAN JOAQUIN ST., STOCKTON, CA 95201-388 <br />(209) 468-3420 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRONMENTAL HEALTH <br />(Complete in Triplicate) PERMIT! SERVICES <br />APPIJCATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br />JOAQUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9-1 11 5.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. <br />JOB ADDRESS/OR APN# 2701 N. Wilson Way cfry Stockton, CA 95205 PARCEL SIZE/APN# <br />OWNER'S NAME U -HAUL Company of Fresno <br />ADDRESS7 49 N.Blackstone Ave, FresnoPHONE a'. (209) 487-1723 <br />CONTRACTOR Spectrum Exploration, Inc. ADDRESS 2365 Wigwam Way Licit 512268 PHONE if( 209) 465-8712 <br />SUB CONTRACTOR <br /> N/A <br />ADDRESS Sthckton , CA 9 520 5 Lic# <br />PHONE # <br />0 DESTRUCTION: <br />CONSTRUCTION SPECIFICATIONS A 11 <br />DIA. OF WELL EXCAVATION 8" DIA. OF CONDUCTOR CASING N/A D <br />'...-. <br />TYPE OF CASING/STEEL/PVC PVC DIA. OF WELL CASING 4" c <br />DEPTH OF GROUT SEAL 58 SPECIFICATION Scheathile 40 q <br />GROUT SEAL INSTALLED BY lauffl <br />GROUT SEAL PUMPED: R Yee 0 No <br />Slurry GROUT BRAND NAME <br />CONCRETE PEDESTAL BY DRILLFR: [ayes 0 No <br />Vnlrlay E <br />S <br />LOCKING CHESTER BOX/STOVE PIPETraffi r Box S <br />OTHER <br />INTENDED USE <br />INDUSTRIAL <br />DOMESTIC/PRIVATE <br />PUBLIC/MUNICIPAL <br />IRRIGATION/AG <br />El MONITORING <br />APPROX. DEPTH <br />TYPE OF WELL <br />OPEN BOTTOM <br />GRAVEL PACK/SIZE No. 2 <br />DRIVEN Monterey <br />OTHER Sand <br />95' BGS <br />PROPOSED CONSTRUCTION/DRIUJNO METHOD: MUD ROTARY AIR ROTARY X AUGER CABLE <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 IJCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK 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 FOLIO 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 <br />CALIFO APPUCANT MUSICALE 24 HOURS ADVANCE FOR ALL REQUIRED INSPECTIONS AT (209) 468-3423. COMPLETE DRAWING AT LOWER AREA PROVIDE . <br /> Title Date is- 7S <br />PLOTPLAN (Draw to Scale) Scale to <br />NAMES OF STREETS OR ROADS N ST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />OUTLINE OF THE PROPERTY, GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br />STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WAL(S. ON THE PROPERTY OR ADJOINING PROPERTY. <br />Application Accepted By <br />Grout Inspection By <br />DEPARTMENT USE ONLY <br />Date PV 72 Area 611/ <br />Date Pump Inspection By <br />Date <br />ACCOUNTING ONLY: AIDS FAC# <br />PE CODES FEE INFO AMOUNT REMITTED CHECKS/CASH RECEIVED BY DATE ' c' IT/SERVIC .. ,. •,.1..,: INVOICE <br />:-50 / 441) 87 ---- o f 3 A..... - ,f,..," -,i()29.0 76e.