Laserfiche WebLink
•••• <br />Applloollon Am:tooted By ( A14:-N,1 <br />Oroul Impeetle.1 By (ics>,..-LAAACY7A Dote Porno Inspection By <br />Dnelmellen fmreetlorl Ely <br />wcsr <br />2. <br />Coi-vID P7 <br />FL,mP -41•4'1; <br />Loo4ri5cAll <br />0 <br />Atom <br />Dots <br />— — <br />I 1.4w - <br />f-caFA-t <br />TN*/ k <br />• <br />0 1- <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 />(Cotnpkts In Tr!primal <br />APPLICATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE VVOW 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 />JOB ADDRESS/OR ARM C L41 (-54 L nut's e CITY e e_01 PARCEL SIZ ..)F7 - 244)- 2 <br />46101 6v1-c..-pe; se. ..34 SVC OWNER'S NAME 9„:le K4.43 k4r4r-ke_45 Ztut ADDRESS r ,4 9 1I smg - 76c. c PHONE St co 57- SSeuza <br /> <br />-IbLo le...Or ex.-444—iO Srt. L3Y , , . <br />PHONE S 424 -S353" CONTRACTOR 408=1:1110 75-- c , „ ADDRESS pie01.144.40.4Js cA 9:44144. LJCS <br />38 66,3 cieve_imv Ave. C 5-7 4/4z SUS CONTRACTOR p„c gr..oc ADDRESS ace F A 95-N, C troff 2 4.S.5.11.0 PHONE II yag - 44o0 <br />TYPE OF WELL/PUMP: I . NEW WELL 0 REPLACEMENT WELL <br />01 INSTALLATION 0 WELL SYSTEM REPAIR <br />iXt MONITORING WELL S 0 OTHER <br />J El CROSS-CONNECT REPAIR 0 VAPOR EXTRACTION WELL S <br />0 Now 0 Repair H.P.DEPTH PUMP SET FT. FIRST WATER LEVEL (TYPE OF PUMPI <br />0 OUT-OF-SERVICE WELL 0 GEOPHYSICAL WELLS 0 SOIL ammo ,/ <br />0 DESTRUCTION: <br />INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS <br />0 INDUSTRIAL 0 OPEN BOTTOM <br />. <br />DIA. OF WELL EXCAVATION G it.) cAteS DIA. OF CONDUCTOR CASINO <br />AS4....4_. ....Lig A 4-'-- <br />0 <br />TYPE OF CASING/ST EE1JPVC Pvc_ 5jj.., 4-0 DIA. OF WELL CASINO i o..; C ,2 -it 0 DOMESTIC/PRIVATE <br />0 PUBLIC/MUNICIPAL <br />IV GRAVEL PACK/SIZE 4/2- 54-ek 0 (' <br />0 DRIVEN DEPTH OF GROUT SEAL lis Pts...te I- SPECIFICATION Fr 0 IRRIGATION/AG 0 OTHER GROUT SEAL INSTALLED BY Trir0-0:c- C.n.fif GROUT BRAND NAME fikit k.,..r 4.-c_ <br />tit MONITORING <br />S -r-t r 1- <br />GROUT SEAL PUMPED: IXI Yon O N. CONCRETE PEDESTAL BY DRILLER: fil Yoe O N. S 1,....f <br />APPROX. DEPTH LOCKING CHESTER SOX/STOVE PIPE___ s <br />PROPOSED CONSTRUCTTONMIVLUNG METHOD: MUD ROTARY AIR ROTARY AUGER CABLE <br />OTHER <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE LAWS, AND Roue 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 WORK FOR WHICH,/ <br />THIS PERMIT IS ISSUED, ISHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA. CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIElf-/ <br />THE FOLLOWING: ' I CERTIFY THAT IN THE PERFORMANCE F THE WOW FOR WHICH THIS PERMIT 18 ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OP' <br />CALIFORNIA.' THE A ANT MUST CALL 24 HOURS A ANCE FOR ALL REQUIRED INSPECTIONS AT 12081481-3423. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br />Stoned X tail 4,0 TM* PI/113' .C.C...1- a 1,-^/ .....‘711,- 4,-- S841-7_ Dots 2-22 <br /> <br />PLOT PLAN (13low to Soots) Seale 1 si • to XID I <br />NAMES OF STREETS OR ROADS NEAREST 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 L. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br /> <br />STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. ON THE PROPERTY on ADJOINING PROPERTY. <br />Commentir <br />ACCOUNTING ONLY: AIDS FACE <br />PE CODES FEE INFO AMOUNT REMITTED CHECKS/CASH RECEIVED BY DATE PERMIT/SERVICE REQUEST NUMB INVOICE <br />Pub Health Serv. - Enviro. 173 (1/97)