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11—OS-1997 1:55PM FROM P.2 APPLICATION FOR WEL IPUMP PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 9520 (209) 468-3420 t'� �, Y NOW-RFUIOABLE PEARIT UPIRES I YEAR FROM DATE ISSIIEA j�T ' 1 � 00 iCampLa k Trfptkatai sC.� �•y�_; . APPLICATION 16 IfEPE BY IJIAOE TO THE SAH JOAOtUN COUNTY FOR A DCONSTRUCT'QaT TO ANUAR NBTALL THE WOM DESCRIBED. TWO APP MATKM mi- j tE:..q�royi�tAN�F yyRil SAN JOAGUIN COUNTY DEVEIDO%ACNT�TrrTLE,-1IfyC14AFTER 9-1116.3 A" TIE STANOAJIDS OF IAM JOAaM COUMSY PLOOM HEILTH 6ERVK�6. ETtVAaDMUENiAE Joe AOORESIBIOR APNJ 3 00( W� n 1� C CITY / OWNER-BNAME J ✓>•J f r L Pr-, 77�n ///7� PlafpltEf�j-6j'I SVS CONTRACTOR 5 LC C) =V)/-�/,,.... �.: I n r AODItEGdw/ 7 11).5.., �-",> rG i k 1,2- ucff i fklY l _ mow e9Z6 1 -1 / �L 1 I BUB COMPACTOR 'C� C' 4 e. - i �r i / I I n (,. J r I) . ADOREte 3Z ��-J pY Z CP�c M� e (1C� POE I �/ h D TYPE OF WEL,L/i'VAPP, ❑ NEW WELL ❑ REPLACEMENT WELL U(MOImOPaO vvT L % I✓e I /5 ❑ OTHER - - ❑ INSTALLATION ❑ WELL SYSTEM WPMR ❑ CROGS.CO►14*CT WPAffjAL,, / p /} Cl VAPOR EXTRACTION WELL f J ❑ N.r ❑ PP -" "-P- DEPTH PUTS BET R- D FtRBT WATER LEVEL O (TYPE OF R1MPI ❑ OUTof-nvr ICE WELL ❑ OEOPIIr A& WELL f ❑ Cort BORIIXi f ❑ DESTRUCT oM, INTENDED U[i Tyr%OA WELL CONaiaur TION spVC104CATON& C ABN PwcaVET! eT 1,3 z S N-� ❑ NDUSTMAL ❑ OPEN BOTTOM OLA. Of WELL EXCAVATION // ✓ � DU DIA. OF CONDUCTOR CASING EJOOT.IE8TICIPICVATE ❑ ORAVU PACXIBTZE I� V- TYPE OF C !' AWNGXTEilRVC V DIA- OF W.TLL CASEINS ❑ PktOMXNNICWAL ❑ DTPVEH OMH Of GMUT VAL I ' - , 3 c -d I. S —L(S SPECIFICATION ❑ IRRIGATIOWAQ ❑ OTMER GROUT SEAL NSTALLED BY GROUT BRAND NA AE rn Ft/910 WTOMM0 G LIT SEAL PU%XPV0- ❑ Y.. ❑ N. CONCRETE PEDESTAL eY DMLLER: ❑ Yw ❑ Ne —X. 0—w h � G ✓7 rA `7 iJ -45-:f LAOCnM CNESTER//BOX/STOVE PIPE PROPOSED co N2TRUCTTOKMM.Uwa kM5400: LR10 FlOTARY AIR ROTARY / I, , 4 iAUGER OTHER 1 HEREBY CERTIFY THAT 1 NAVE PREPAPED TMG APPLICATION AND THAT THE WORK WILL BE DONE IN ACCOODANCE WITH BAN JOAQU N COUNTY OROYNANCEG. STATE LAWS, AND RULER AHO REGULATIONS OF TME GAN JOAQUITU COUNTY. HOME OWNER OR LICENSED AGENT -S MMATURE CERTIFIES THE FOL.LOUANO: -1 CVnTWY THAT N TME PEAFORIUA"CE OF THE LIJOfW FOR WHICH TWO PERMIT re tSSUEO, 1 GRALL NOT EUtUSOY PERSONS SUSACT TO WOWWAN-8 C0640ENaAT10R LAWS OF CALFOF"A.- CONTRACTOR -8 WMF40 OR BUB CONIVACTOOG SIGNATURE CERT6TE8 THE w0LLpyVWG: - I CEK, TIFY THAT M/ TL/E PEPFORYAHCE OF TME WOW FOR NMKH TI118 PTF"T IS ISOUFD, 104ALL EYPIAY PEftPONS VUBJECT TO WO6t4aAK8 CO/JPFTItATION LAWS Of CALK0I6/1A_' THE APPU ART rCrCAIJ;,a FXrURA Of ADVA14CS POR ALL REOURED r%%rl CTIONB AT Pool s4tssl:t2, COUMM ORAVANG AT LOWER AREA PPOWMED. ROT PLAN 00- + to S -W G1tLL. ' to 1. NAMES OP STREETS Oct ROADS NEAR68T TO OR eOVNpINO THE FMISRTY. A. LOCATION OP HOUSE SEWAGE DISPOSAL BTBTUA OR MOM CEO 2. OUTLINE OF THE PROPERTY- G[VNO mAENBnOH{ AND, NOImI OtMcYroN_ pLPA48ION OP eEWAOE DISPOSAL eYsruue- 7. DI{.tENWONED OVTVWS ANO LOCATION Of ALL EXISTING AND PROPOSED S. LOCATION OF WELL8 %%MWd RAONe OF ONE WJWWWO Fa<TY FT. VTUMCTURES. INCLVOtHG COVERED AREAS SUCH AM PATIOS. DRIVEWAYS, AND WALKS. ON TK P"OPERTY OR ADJOPdm PpOPERTY, : P OfFARTWAg"T USE ONLT O. A lr..emne.+ BT D.I. D 49AfnP LnPo�Aen nm V, I AUw I FAC/ D.I. MUXI' R COOED 35.3(n FIE YTPO 84' AMOUNT FAYATTED Sit- C ABN PwcaVET! eT 1,3 z S N-� DATIE z9 ov rumwTUeamcc R@OUEfT mmm t Sk ge 2 3 3 IIfY01C[ Pub. Ream Sett. - ErMm- 173 (IN7)