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0 SOIL BORING
<br />(TYPE OF PUMP)
<br />0 OUT-OF-SERVICE WELL 0 GEOPHYSICAL WELL
<br />TYPE OF WELL
<br />0 OPEN BOTTOM
<br />CONSTRUCTION SPECIFICATIONS
<br />DIA. OF WELL EXCAVATION 34,9'
<br />AIR ROTARY AUGER CABLE OTHER
<br />(7.7 LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED
<br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS.
<br />LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT.
<br />ON THE PROPERTY OR ADJOINING PROPERTY.
<br />APPLICATION FOR WELL/PUMP 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 />(Complete In Triplicate)
<br />APPLICATION IS HERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN
<br />JOAOUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION.
<br />JAN 2 1 '1999
<br />JOB ADDRESS/OR APN/
<br />OWNER'S NAME bA.1 GP- Ski 6 14.3-0`A ADDRESS 'L1()5 S - LI Alta \ " ca4 PHONES 7 31
<br />CONTRACTOR A1'(,0\.__s ct.,C4"-q ADDRESS I I 13' 1.-14"4:%, 11(3, \ Ve• '6 UC / PHONE 5 5 n --i,"1
<br />SUB CONTRACTOR \I :' A ':/‘ ,t4) ADDRES8 OC kg 61 , K4-424:1 tk.,) 1.... uc, 17zA.) c 9 PHONE IX) TN-
<br />TYPE OF WELL/PUMP: 0 NEW WELL 0 REPLACEMENT WELL 0 MONITORING WELL S 0 OTHER
<br />0 INSTALLATION 0 WELL SYSTEM REPAIR 0 CROSS-CONNECT REPAIR tirVAPOR EXTRACTION WELL
<br /> 0 New 0 Repeat H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL
<br />.'DESTRUCTION: V4VQ knrt,
<br />ois c
<br />110 5cir\b(t.. CITY SiloL PARCEL SIZEJAPN2 /1:1-31, Is-- 6
<br />INTENDED USE
<br />INDUSTRIAL
<br />DOMESTIC/PRIVATE 0 GRAVEL PACK/SIZE TYPE OF CASING/STEEL/PVC
<br />PUBUC/MUNICIPAL 0 DRIVEN DEPTH OF GROUT SEAL
<br />IRRIGATION/AG ,,OTHER GROUT SEAL INSTALLED BY .1' revA,ry-- ,‘
<br />rMONITOFUNG GROUT SEAL PUMPED: trYce 0 No
<br />APPROX. DEPTH
<br />PROPOSED CONSTRUCTION(DIELUNG METHOD: MUD ROTARY
<br />30
<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: 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH
<br />THIS PERMIT 18 ISSUED, 1 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
<br />CALIFORNIA.' THE APPUCANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT 12011 401E4423. COMPLETE DRAWING AT LOWER AREA PROVIDED.
<br /> Title "---B -A- C.L., Vs-4- k 6/10.- V D•Is h (11 81prted X •
<br />PLOT PLAN (Drew to Seidel Scale
<br />I. 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 WAL.A11.
<br />D.,. o/ zi /f1
<br />ACCOUNTING ONLY: AIDS FACII
<br />PE CODES FEE INTO AMOUNT REMITTED CHECKS/CASH R CB",S DATE PERMIT/SERVICE REQUEST NUNIBER INVOICE
<br />3coZ- 60.00 if isys iff of • ... P Ail ai
<br />Pub Health Serv. - Enviro. 173 (1/97)
<br />to
<br />Nt,
<br />A
<br />DIA. OF CONDUCTOR CASING
<br />DIA. OF WELL CASINO
<br />SPECIFICATION
<br />GROUT BRAND NAME tt•V•leAt- EL,‘,,ektrijvi
<br />CONCRETE PEDESTAL BY DRILLER: 0Y.. tg No
<br />LOCKING CHESTER BOX/STOVE PIPE
<br />DEPARTMENT USE ONLY
<br />ApplIcellon Accepted By
<br />'Ail A .
<br />t'" cAs,Aqs (-Jr\ [22rONA€ko (074e_ c),:s9 r' di/0
<br />, ;04-ct< of2A4-1-'4. \i V& *-1 e, 1A42_ A .1/
<br />Grout Inspeetkm By at. Pump Inspection By Dote
<br />Do don IrepectIon By mj_ Date
<br />—
<br />N1N71j,-
<br />i0/vvo
<br />8-14/MW 5
<br />WEST SONORA ST REE I
<br />151
<br />BRICK
<br />BUILDING
<br />MW-3
<br />Ettel.NThIKM
<br />B -14 /NW 5 +
<br />110
<br />0 -11,40 5 4/
<br />Soil Demo
<br />B000yMoollowy Mat
<br />5*1 Bo00/8etorel, Well
<br />Sod Bonny/Wm EI.1.01,01 00
<br />APPROXII.IAIL SI AI I
<br />IA FHA
<br />GENERALIZED SITE PLAN
<br />FIRE ENGINE COMPANY No.2
<br />110 WET SONORA STREET
<br />STOCKTON, CALIFORNIA
<br />AIO NAM A 1 III
<br />FIRE ENGINE COMPANY No.2
<br />STOCKTON, CALIFORNIA
<br />Alty
<br />1180490 I
<br />AS SI 10W11 I 1 GU 1(1. 2
<br />oitAttmo• 1/11.1111 11
<br />AI I
<br />deSuf1, f 00 11(0010
<br />WO I, COO NI t;:"I't:,, Unit ISSUE / RE VISION
<br />..
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