Laserfiche WebLink
INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A <br />INDUSTRIAL 0 OPEN BOTTOM DIA. OF WELL EXCAVATION DIA, OF CONDUCTOR CASINO 0 <br />DOMESTIC/PFUVATE .12-15-/LAVEL PACK/SIZE '11.. 3 TYPE OF CASING/S1EEL/5 411r 40' 02.- DIA. OF WELL CASING <br />oi:' <br />0 PUBLIC/MUNICIPAL 0 DRIVEN DEPTH OF GROUT SEAL ..+4-1-' 02 *._ SPECIFICATION <br />IRRIGATION/AG 0 OTHER GROUT SEAL INSTALLED BY 2)Yr //k...-- i'....--- GROUT BRAND NAME eP4.4(2-7?-, E (J <br />1ONITORING GROUT SEAT PUMPED: 0 Yee ON° CONCRETE PEDESTAL BY DEUU_ER: 0 Yee 0 No 5 <br />c::)APPROX. DEPTH /5 -.C'- LOCKING CHESTER BOX/STOVE PIPE 5 <br />PROPOSED CONSTRUCTION/DRILUNG METHOD: MUD ROTARY AIR ROTARY AUGER CABLE ‘,/ OTHER L>...) <br />DEPTH PUMP SET FT, <br />TYPE OF WELL/PUMP: 0 NEW WELL 0 REPLACEMENT WELL P"'TGEONITORING WELL I / 0 OTHER <br />0 INSTALLATION 0 WELL SYSTEM REPAIR 0 CROSS-CONNECT REPAIR <br />0 New 0 Renck H.P. <br />SOIL BORING 0 OUT-OF-SERVICE WELL 0 GEOPHYSICAL WELL 8 <br />(TYPE OF PUMPI <br />(A...el I 401TRUCTION: <br />VAPOR EXTRACTION WELL E <br />FIRST WATER LEVEL <br />'to <br />4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />S. LOCATION OF VVEL111 WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br />ON THE PROPERTY OR ADJOINING PROPERTY. <br />PLOT PLAN Prow to Seale) Poole <br />NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. <br />2. OUTLINE OF THE FROPERTY, 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 />AIDS <br />ApplIcetIon Aceepted Egy <br />Oroul Inspection By <br />Onotrimtion In•poctIon <br />Comments, <br />7C <br />ACCOUNTING ONLY: <br />DM* <br />DEP TMENT USE ONLY ( <br />n By Dols I ,rnis Inasec <br />, Lier- ri - <br />Dote <br />I FACE <br />PE CODES FEE INFO Ar UNT orTED CHECKS/CASH REC VE Y DATE PERMIT/SEFIVICE RECIVEST NUMNER INVOICE <br />..--7 .-- •••% 49 <br />VIO ••••'"----- i 22)5 <br />i <br />" t i 1c727-1 <br />(_S (1). 0 0 \ A 7' <br />Pub Health Serv. - Enviro. 173 (1/97) <br />fF <br />APPLICATION FOR WELLJPUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION MAY 1 8 1999 <br />x/9/11 fid <br />, NOWREFUNDARE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />(Complete In Triplicate) <br />RN/ICES <br />i:'.ALTH 304 EAST WEBER AVENUE, STOCKTON, CA 95202, ,....,,, ji.,tis, 6ENTA HE ALT L H <br />(209) 468-3420 PERmn- I SF <br />11 rdS7 Le. d ,..., <br />APPLICATION IS HERE BY MADE TO THE SAN JOAQUIN C NTY FOR A PERMIT TO CONSTRUCT Arinton INSTALL THE VVOFI( DESCRIBED. THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN <br />JOB ADDRESS/OR APNE 5/0P--77,31 4..) E"--'7,6 , r (- ) , a v- <br />JOAOUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9-1116.3 AND THE STANDARDS OF S N JOAQUIN COUNTY HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISr. <br />CITY141/0C- la---g:3- PARCEL SIZEJAPNE C I 7 -11(' - I --1 <br />OWNER'S NAME <br /> foi <br />t.,., f "4".---"C...47---- 5--t-cr p.....--in...\ ADORERS /2B IQ D-R---11A et"—',,fit-/--6 PHONE # r3-2 6VP"2-C. <br />. <br />CONTRACTOR AellrA r-e04., C1-642 .'', 1 (;)-Artb ancetres46a5 Ai4)eTt4 wiamc), ,8-h-e-Z7XioNE , 1/62 /306, <br />SUE CONTRACTOR aooneee '''"C-125 qe--tat...\ <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 owIrta OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICIL. <br />THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY PERSONS auttrecT TO WORKMAN'S COMPENSATION LAWS OF CALROFINIA.- CONTRACTORS HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES <br />THE FOLLOWING: I CERTIFY THAT IN THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br />CALIFORNIA.• THE APPLI .LII.;.1.1 MT CALL 24 IN ADVANCE FOR ALL REQUIRED INSPPC T 120014 -2421. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br />Title D.,. <br />-sx <br />UCE PHONE # <br />Signed X