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• <br />MIN <br />6744o <br />APPLICATION FOR WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEAL11-1 SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br />(209) 468-3420 <br />/10/1•REFUNDARE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />(Complete In TrIollea1s1 <br />APPLICATION 19 HERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION 18 MADE IN COMPLIANCE WHIT SAN <br />JOAQUIN COUNTY DEVELOPMENT THAI, CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH 8ERVICE9, ENVIRONMENTAL HEALTH DIVISION. <br />JOB ADDRESS/OR APNO 114nn Koster Road CfTY Tracy PARCEL 81ZEJAPN/ <br />OWNER'S NAME New Jerusalem School District ADDRESS 31400 Koster Road PHONES 835-2597 <br />CONTRACTOR Condor Earth Technologies, Inc. Am", Stockton <br />UC/ <br /> <br />PHONE S 234-0518 <br />Spectrum Exploration AD00E/382365 Wigwam, Stockt,512268 PHONE / 4 1)7--8712 <br />0 NEW WELL <br />0 INSTALLATION <br />0 Now 0 Repel/ <br />0 REPLACEMENT VVELL <br />0 WELL SYSTEM REPAIR <br />H.P. <br />Ell MONITORING WELL S 3 0 OTHER <br />0 CROSS-CONNECT REPAIR <br />DEPTH PUMP SET FT. <br />0 VAPOR EXTRACTION WELL ! <br />FIRST WATER LEVEL <br />0 OUT-OE-SERVICE WELL 0 GEOPHYSICAL WELL 0 ROIL BORING <br />SUB CONTRACTOR <br />TYPE OF WELL/PUMP: <br />(TYPE OF PUMP1 <br />0 DESTRUCTION: <br />TYPE OF WELL CONSTRUCTION SPECIFICATIONS A <br />0 OPEN BOTTOM DIA. OF WELL EXCAVATION 9" DIA. OF CONDUCTOR CASINO NW 0 A 0 <br />El GRAVEL PACK/BITE TYPE OF CASING/STEEL/PVC pvc DIA. OF WELL CASING 2 " D <br />0 DRIVEN DEPTH OF GROUT SEAL 0-7 SPECIFICATION R <br />0 OTHER GROUT SEAL INSTALLED BY Dr i 11 Pr GROUT BRAND NAME E <br />GROUT SEAL PUMPED: 0 Ye. 0 Ne CONCRETE PEDESTAL BY DRILLER: 0 Yee O N, S <br />0.7 1 <br /> <br />LOCKING CHESTER BOX/STOVE PIPE 5 <br />PROPOSED CONSTRUCTION/DIBLUNG METHOD: MUD ROTARY <br /> <br />AIR ROTARY AUGER .1(, CABLE OTHER <br />INTENDED USE <br />INDUSTRIAL <br />DOMESTIC/PRIVATE <br />PUBLIC/MUNICIPAL <br />IRRIGAT/ON/A0 <br />El MONITORING <br />APPROX. DEPTH <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 JOAOUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br />TIPS PERMIT 18 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 114 THE PEFOIWIANCE OF THE WORK FOR WHICH THIS PERMIT 19 ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br />CALIFORNIA. TH APPUCANT MIJST 9AU. 2 ADVANCE FOR ALL nrotenno INSPECTIONS Al 1201114411-3423. 1T COM E DRAWING AT LOWER AREA PROVIDED. 4 <br />r- <br />. <br />Title ' Marini-1+g Geul-rmis L r- , /41,1 Date 11/23/98 <br />PLOT PLAN Prow to &nolo) Scala <br />NAMES OF STREETS OR ROADS PAREST TO OR BOUNDING THE PROPERTY. <br />OUTLINE OF THE PROPERTY, 0 MEMNON@ AM NORTH DIRECTION. <br />DIMENSIONED 01/TUNES AND MleAT/ON OF ALL EXISTING AND PROPOSED <br />STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. <br />to <br />4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM on PROPOSED <br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />S. LOCATION OF WELLS WITHIN ItADfUll OF ONE HUNDRED FIFTY FT. <br />ON THE PROPERTY OR ADJOINING PROPERTY. <br />See Attached Diagram figure 2) <br />DEPARTMENT USE ONLY <br />ApplIcotton Accepted By C"" Dote /c;) - 7 0 .7 VT," <br />- Date /)--1.2.*Purnp Inspection By owe <br />/e k d <br />Dote <br />zed, h/oc e c, cyf'' lyt_S" 1-4 it 6_1/ Coninwets, <br />-,11) Q e,"-4 • 41 _r <br />ACCOUNTING ONLY: AID/ FAC/ <br />PE CODES FEE INFO AMOUNT REMITTED Pal /CASH RECBVED BY DATE PERMIT/SEFIV10E REQUEST NUNISER INVOICE <br />33701 S.1.Ci --- 41-1 ---- 3 ,1 701/_ c .... 4 ...) 1 al 7/c s- a_00, 77 9r <br />Pub Health Serv. - Enviro. 173 (1/97) <br />of eC-8(-1 1414--e-7461-'eed <br />/ <br />On•trocIlen Impaction By