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P 1 3-17-1997 10-fS-IAM'h FROM ;� �Z OPLICATION FOR WEL LJPUMP PERMIT* r�eD i IM SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES � X C�I0) gas - C/ ENVIRONMENTAL HEALTH'DNISION 9n B 304 EXIST WEBER AVENUE, STOCKTON,CA 95202 (209) 488-3420 ROM REFUMDAR(,t pERMTT EXPIRES I TEAR FROM.DATE ISSUED (Comptato to TfI;IIk>•ta) A-1-fCATION IS IfERF(1Y HADE TO THC SAS+JOAOPN COVKtY FOR A PQuAIT TO COKCTRUCT AND.c70.iN87ALL THE T'VOSK DEfiGPoH£D.Ytua AVPttCATION U:MADE tN COMFUANCE WTT'I SAN JOAUUIN COUNTY DEVELOPMENT TITLE.CHAMIA 9-111 S_3 AHO THE STAND/A �RDS OF EAN JOAWIK COUNTY PUBLIC-HEALTH SEINIC£B,F_HVIaONMENTAL HEALTH OM810N_ Joe AooaEsa.oaAr..� /� ?31-3-7 S o U 1� Ai r I -y+ W V v CITY �G k l v,I PARC-a WZF/APNT 1 7 Ac,rec, (� �(��,,�a •� /7'l/ ` - .• ,,p -2- o-WEA-9 NAME F�� /TL.:Ti1/i G�, 1-✓Tc. — � P�I V/ heSAOOP.- ?do'` WILO II 2S ` 2101 W� s s ff', F1 K. ✓?J,OrB�rl- �oBC, coNTRAGToR a��olll l 1 Yl2-GVi YID ��•e-� �••I^C Ao«acse C Ucr {� ftlS CONTRACTOrt 71'i�liY1� ( T�V1G. � �f3! R'esr�vt Q• 001) 357- cUl TYP£OF WELyp 1M- ❑ NEW WELL ❑ PaMACEMEW WELL ❑ mowroNNa WELL 0 �OTHEa LJf ! B O t"l'1.� ❑ R(aTALLATION ❑ WELL 6Y9T£M WPARP ❑ C1q SS.CONNECT i+EFAIn ❑ VAPOR EXTRACTION WELL fes_ J ❑N..v Q P.e.l. r..v. DCPTTf PV"P OFT FT_ "PIT WATTIA LEVEL_yC5 O (TYPE OF FVJ"" Golf.$Ofo!•t0 R t}1 n_ ❑ OVT4f-`6'CEN:LCE WI.0 L ❑ QEOT'�tYSK.l-t'.YELLS-�7 ❑DEf¢TRVCTtO N. A II ✓K'Z L/'L�X� fes- C�,'JG.� Lvl ' '` LIZ- -tet A INTENDED UaE TYVI,OF W CONR:TicVC TION}PEC04CATIONS ❑ 1lAWSTRIAL ❑OPEN BOTTOM CIA.Of WEU.JXCAVATION WA.Of CONDUCTORCASINO U TYPE OF CA£"G GTEEI/-j DUI.OF WELL CASINO O ❑ DOHEBTRCJVRIVATE ❑O1tAVEl PAC1TIaTZE ❑ PVBUC/MUNlCIPAL ❑tNaVEM OFDTH OF GROUT GE.AL SI`ECtFICATION A ❑ IPJ;10AT10N(A4 ❑OTHEa CROVT CFAI_ NgrAfLEO sY OROUT BfLMAO NAM£ E ❑ upNfTO WKO OROVT gFK PVI•IPEO:❑Ys+ ❑ CONCRETE PEOEBTAC BY ORTLLER:O Y.. ❑N. S LOCXuoG CHL BTER tiO XlaTOVF t'IT� - (� S APR2O7L DUrTN - CP MoP06ED CON[TnUCT10KIDIRLUX(3 MLY1100: IAUO fIOTARYAIR WTARY AUGER CABLE OTHER I V<`Zay CERTIFY TI4AT I HAvE Ps¢PA><£O YI lQ AMUCAT10H A140 THAT TNF V+OPK YMi EF Dot*@t ACCOhDAt+CE WY-04 BAN JOAOUIN COUNTY OPOINANCEB.CTAYF IAW9-ANO RUtko ANO ItEGtILATtONB OF THE qAM JOAOVM COUNTY, HOME OwKEa OR LJCEKS3E0 AaEKY'S atcNATV11@ CTRTIHE9 THE MLLOW0 t'I CERTIFY THAT IN THE PS"FaAANCE Of Tf(E Womr POR WHICH 7MS PEiy tK 18 IS SUED.(stlAtl NOT F}APLOY PERSOKe t:TJ6lFCTTO WORa,MAR's CCAAf%6W61k tOR LAWS OF CAUfop"A-, COKT,u CYCR•8 H+MNO OR RU5-CONTRACTtNo fi1CNATURf CERT(f1EB THE FOLLOWING: '1 CEJTTIFY THAT IN TILE PERFORMANCE OF THF WORK roR WHICH TMS PfNK(T 10 IS8tTFD-I sr+Atl p�APLOY Pf ROOhB SVEJFCT TO VYVRA-c^r" CO+•cPt7t.Al1GN UWS Os CAUfOf+Nl.l� THC AssuCAKT MVtT CALL 2A HOVRLf W AOvmJ clg POit ALL RwDUYlsm INArTcTROKt AT,. I'k/•Z'-_9'f=. CommcTE DRAWING AT LOWER AREA PR') y� VQ.a/lJ S/ S O.t. >3�,.a z ie vc t - y. t�C� Trv. ��Lc�Z Kot PLAIT(Q. b vow R- NAAAEB OF eTREETS Opt ROADS NFAMST To OR BOt1KOIN0 TH.E�wPrF-IwN��EnRfTlV. A. LOCATION OF "Wjki O CISPOWACLE DISPOSAL f1YSTEM OR PagnOGfA 2. OUTLWE OF THE PROPliLTY.Pts VINO owENg10Na ANO NORTH ORIECTION. fXIFANQION OC SEWAOE OIBPOfAL 6Y6TEMs. �. D*gwI;jOWD OUTUNF,o AIA t,OCATWN Of ALL tXrOT910.ANO P111*00"D - t. LOCATION OF WELLS VATMN FrAme OF ON!"v"veED FIFTY FT. BTRUCT«g.INCIVO(NO COVVW0 AP4EAa BITCH AO PAT1O9.OgtVEWAYtf.ANO WALK11L pN THE P}IDP'EAI'Y Oa AO•I01EhMQ pf1004lCTY. �.. y P� ........... ,,....: ...�............ .. .... P- PLIZ ... : .. : . . .. , . : . 4.. :. : .........�..................:.... .. .. - i ..... ..t.. ........,.......:... .. ..... D9ARTb4am use4mmy A.PR.«I.n Aee.ei.e aT a..0 6....-r4.t)T 0." Pt.RR Yw..�sn OT bK. O.I. p,�,.etb..t.�wst4w Uy ACCOUNTMG ONLT: Alp/ - FACT /E COtTEf �ftE TWO 'AMOUNT R EFART w f sr OA ►9IMtT/tE]avICL REQUERT NUIIAfIf�t INVOICE wm L