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SAM( `O QUIN COUNTY PUBLIC HEALTH SER;.�ES NVIRONMENTAL HEALTH DIVISION �J 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ICempl4tf In TFlplket4 APRJCAI ION IS HERE BY MADE 10 THE SAN JOAQUIN COUNTY FOR A PERMIT 10 CONSTRUCT AHDIOR INSTALL TIIE WOR(DESCRIBE().THIS APPEICATION(R ii IN COMPLIANCE WHIZ SAN JOAQUIN COUNrY DEVELOPMENT TITTLE,CHAPTER 01.1115.3 AND 111E STANDARDS OF BAN JOAOUIN COUNTY PPUBLIC II/EAALTII SERVICES,ENVIRONMENTAL H HEALTQIVIJION. Joe AODRESeNR-APP'N/F �-�5 r So,_-ck A I r D r.G CITY_ Ao o_K.-EO✓l. FARM BUEJAPN/ IG 9 )ZD 6 3-7 /I OWNER'S NAME / Y1t•_ �C IJ r,LIM1Scla1 - \ ADDRESS 8)2a< 1830 Sir 4,p 5. /* 011rrmw13)4-2.59 -707) L pHS„fiA n'C ! � n of b a _-eu.oenrnO ��;I,p LVIf.BS (,l YrJ. �d /'h. `�� ADDRESS PO HDX T_30 S71„n,c LICE RIONEI GIV-ZS1-7173 D ,1 csLx BUB CONTRACTOR L�rLAA DYI II.^D ADORESq NSO }IDJe: RD<d LIi S RIQNE/9 LS-.T 13-SBD TYPE OF WItUPUMP: �J NEW WILL ElT I REPLACEMENT WELL YD MONITORING WELL I -� pl OTHER Ce^ / TAN ��. qp/Iwq ❑ INSTALLATION ❑ WELL BYST EM REPAIR ❑ CROSSCONNECT REPRO 1113 ❑ VAPOR EXTRACTKIN Will.F J ❑N.11 ni H.P. DEPTH PUMP SET_fT. G ”e RRBT WATER LEVEL 0 (TYPE OF PUMPI ❑ OUTCF-BERVIOE WELL ❑ GEORTVSICAL WELL I SOIL BORING ❑DESI RUCTION: _ INTENDED SE CONSTRUCTION SPECIFICATIONSA ❑ INDUSTRIAL ❑OPENBOTTOM DIA.OF WELL EXCAVATION DIA.OF CONDUCTOR CASINO 0 ❑ DOMESIICMYVATE ❑GRAVEL PACKJBIZE TYPE OF CASINO/BTEllui DIA.OF WELL CASINO 0 ❑ MWLICJMUNICIPM ❑DRIVEN r DEPTH OF GROVE SEM SPECIFICATION A I ❑IIVSOATIONIAG ❑OTHER GROUT BEM INSTALLED BY GROUT BRAND NAME IF If 34 MOMIONNOO f�Gt - GROUT BEM OCKINODCN❑E@Y. BO❑XRTOVE RPE N. CONCIIETF PEDF@YM 1Y pRIIZFR❑Yw [IN. J APPROX.DEPTH 1. MOSCOW CONSTRUCRONIDRLLINQ M"MIN MUD PDTARY AIR AOTMIY AUGER CABLE - 01HE COMC V\LVG'W.'EG✓ 1 I IIEREIY CERTIFY TIIAT 1 HAVE PREPARED THIS APPLICATION AND TIIAT TIIE MM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OROINANCEO.STAT C W@.ANO RULES AHD REGULATIONS OFTHE BAN JOADUIN COUNTY. HOME OWNER OR LICENSED AOEM'S SIGNATURE CERTIFIES THE FOLLOWINOt'I CERTIFY THAT IN THE PERFORMANCE of THE WOR(FOR WHICH 11118 PERMIT IS ISSUED,I WALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN-4 COMPENSATION LAWS OF CMIT001 .- CONTRACTOR-@ HIRING OR SUB.COMRACTINO SIGNATURE Clifil f THE FOLLOWINO: -1 CEFTIIFY THAT IN THE PERFORMANCE OF THE WORK FOR MUCH THIS PERMIT If ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN-0 COMPENSATION LAWS OF CALIFORRIA.- FPOCMT UST CALL S4 TNI Rf IN ADV OE FOR ALL REQUIRED INSSPICTGNf AT 43"1401 COMPLETE DRAWING AT LOWER AREA PROVI ED. fR.+/K �� TR. E.-TJ wS�. /L�' lowy. l �nc Jns.-C� ONe ��uf9R PLOT RAN 10'..Y 1.Sed.)M.I. 'N 1. NAMES OF OTHEVII OR)GAD@ NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION Of HOUSE SEWAGE gMOSAL SYSTEM OR P OPOBEO E. OUTLINE OF 111E RgPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF OEWAOE IASPOfAL SYSTEM$. i. DIMONSi OUTUNE@ AND LOCATION OF ALL EXISTING AHD PROPOSED 1. LOCATION Of YELL@ WITHIN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS OUCH AS PATGS,DRIVEWAYS,AND WAUR@. - ON THE PROPERTY OR ADJOINING PROPERTY. _ -- 12 1 GROUNDWATER I MONITORING WELLS If ECPT-I PROPOSED CONE PENETROMETER SAMPLE LOCATION - - •CPT-} POTENTIAL CONE FE14ETROMETER SAMPLE LOCATION I I FORMER 20.000 EARTHCRAINS u GALLON DIESEL-FUEL UST PLANT BUILDING (REMOVED 09/89) _E_ { 1 a 3 o MW-3 G MW-13 7 CPT 2 f FORMER DISPENSER IS H FT- W_ MW-12 ,r 0 I 0 y 0 .1 S RCPT-1 O r /MW-8 "WAX i/ FTF— RMER I0.000 LL014 UIESEL-FUCL USI :MOVED 09/89) DEPARTMENT USE ONLY AprlleMbn Aaepld BY ! V Ir .. .. D 1• C� Ne' 7. O`eui MirlN`n BY��i ONi=- fil IMPEegen BY --Det• P.Jr �� !fes ��..�E-fin vE.•C �7 `/�li� 5 `� / ACCOUNTING ONLY, RDE PACO PE CODE@ FEE INFO AMOUNT REMITIED e6'lElKIjDAlN RECEIVED BY DATE PEIMITRERVICE REQUEST NUMBER INVOICE 0(9/c Pub.HeBRR Sew,•Envlro.173(1/97) I' f