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••••,•-. �.��.��.. ��ri�.n� ILL-:)Iu—j`y—IOU 3'.. ..` .... . uct L4.'J'� iO;UU ND.UU3 r.U2 <br />SAN JOAQUIN COUNTY PUBLIC HEALTHIsERVir^ <br />ENVIRONMENTAL HEALTH DIVIS16M <br />P 0 BOX 388, 446 N. SAN JOAQUIN ST., STOCiKTON, CJi OM11.38B <br />(2091409-3420 <br />J f <br />dN N•REFUNDABLE PERMIT.XrJ E8_I_YEAR fRDTII DATE ISSUED <br />iComplatu In Trfpllei6s) <br />Application is here by made to the San JaagU[n County for a permit to construct m d/or fmtalt the work described. This opptication is <br />made in compliance with Son Joaquin County Development Title, Chapter 9-1115.3 end the Standards of San Joaquin County Pt6lic Health <br />Services, Environmaentat Health Division. <br />Job Address/or APNE 177-040--17 city Stoc`kton Parcel sl¢e/APN# 4.4 -acres <br />.I <br />Owner's Nene Stockton Airport IndustriM141ress 1010 2nd Ave.,,-Spii..eno 997.11)1 _ `Phone 46191245—M030 <br />eontracter_ Frontier Drilling Addrrss_123aJ1,%nMQnd, Tmili.r1Q,,Jj. LicN035114 Phone OR(1W201-021 <br />StiJb Contractor _ 1+11A Address �' Lick! Phone a <br />TYPE OF 14EtL1.P11MP•-0 HEW WELL <br />C] REPLACEMENT WELL <br />11 MONITOPIHGIIWELL I <br />OT OTHER Iiydropuncln <br />[I DESTRUCTION <br />[I OUT-01-5EItVICE W -CL <br />(I GEOPHYSICAL WELL # <br />x SOIL BORING <br />U INSTALLATION <br />(I WELL SYSTEM REPAIR <br />U CROSSCONNECT REPAIR <br />i� <br />13 VAPOR EXTRACTION WELL R <br />(] New 0 Repair <br />H.P. _ <br />DFPTN PUMP SET FT. <br />FIRST HATER LEVEL <br />(TYPE OF PUMP) <br />iI <br />IN <br />TEMO USE 13TE Of WELL <br />[I INDUSTRIAL 13 OPEN BOTTOM <br />[] DOMEST]C/PRIVATE V GRAVEL PACK/SIZE <br />(] KMLIC/NUNICIPAL 0 DRIVEN <br />H IRRIGATION/AG ][I OTHER <br />b mcNIToRIN6 <br />APPRd1L OFPTH 50'... -or 3.-eqn. <br />PAMSED CCT KC D ILLIIIB RIETIIDn: HUD ROTARY <br />,tgk <br />CONSTRUCTION SPECIFICATIWIS <br />1��' r <br />DIA. OF WELL EXCAVATIONS-� DIA. OF CDNDUCTOR CASING <br />TYPE OF CASING/STEEL/PVC;l DIA. OF WELL CASING <br />DEPTH OF GROUT SEAL ftll.1 degtll SPECIFICATION <br />CROUT SEAL INSTALLED BY foutiLr GROUT BRAND NAME <br />GROUT SEAL PtWED: 0 Yes. LI No CONCRETE PEDESTAL BY DRILLER: U Yes 17 No <br />LOCKING CHESTER BOR/STOVE PiPE3 <br />,j - <br />AIR RDTARYe AUGER CABLE_ OTHER <br />rJ <br />Thereby certify that 1 have prepared this application 9M that the work Witt be'dune in accordance with SalfJoaquin County Ordinances, <br />State Laws, and Rules Arai Regulations of the San Joaquin County. now owner or liconsed agent's signature certifies the following: 111 <br />certify that in the performance of the work for which this permit is issued, I shall not employ persons subject to WORCHANOS CORPENSATION <br />taws of California." Contractor's hiring or sub -contracting signature certifies the following: o I certify that in the performance <br />of the work for which this permit s fssyed, I shalt employ persons subject to 1IORKMANIS COMPENSATION Laws of California." THEAPPUCANI• <br />MUST CALL 24 NOUSORAVA111 LL ROU1110 ifISPECTIONS AT 1242) 4BR.1423. Complete drawing at Loeser area provided. <br />signed <br />o Consulting EDEIneeT- Date <br />PLOT PLAN (Drew to Scale) Scaled";ta <br />1. Names of streets or roads nearest to or twnrxlinq the property. ,; 4. Location of bourn sewage disposal system or <br />2. outline of the property, giving dixlens(ons; and North direction. , proposed expansion of sewage disposal systems. <br />S. Dimpnsioncd outlines and location of At( existing and proposed 5. Location of wells within radius of 150 ft. on <br />structures, including covered areas such as patios, driveways, the property or adjoining property. <br />and xaikr. SHE PWI-<)SAL LETTER OF XM= 10/19/95 <br />DEPARTMENT USE ONLY <br />Application Accepted 0y Date Area <br />