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ION �AN OAUINTC UNTY UBLIC HEALTH ERVI� ORIGINAL ENVIRONMENTAL HEALTH DIVISION VVV P,O. 81 lX 388, 304 EAST WEBER AVENUE, STOCKTON, CA , (109) 408.3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED NOV 16 1998 APPLICATION 13 NEPE BY MADE i0 THE BAN JOAQUIN OUNTY FOR A PERMIT TO CONSTRUCTMom INSTALL THE WOIK DESCRIBED JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER B-1 16.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC IIEAITII 8 P AW0GZ1tlIOELTOWN IN COMPLIANCE WITH SAN 6�YI� ,r>IEIILTB�IVIBION. JOB ADOgEe8/Oq APIIiari-prWaV. CITY Stockton .1`'Iwslol, OWNER'8 NAME Geo Corp819 S.c/o .M. Equp. ADDRESS PARCEL SIZE/APNI 9th Street, Mod 522-3271 T�,.� Vista CONTRACTOPlZil-Lj %HONER ADDRESS P.OJ30K 51 RTo CV 720% 07 37 281 UCy�I—IWNy PHONE 17lJ1 •JJ4'-W IS PVB CONTRACTOR (]AC'H ADDRESS ltJ�� IJC fax PHONE I El OF WELLIPUMP� NEVI WELL ❑ RE CEMENT WELL MONITORING WELL# faY ❑ INSTALLATION ❑ WE SYSTEM REPAIR ❑ OTHER ❑ CR083-CONNECT REPAIR VAPOR EXTRACTION WELL/ Q'� ❑New❑Repair H.P. J HYPE OF PUMPI DEPTH PUMP BETrT, FIRST WATER LEVEL _ El OP SERVICE WELL ❑ GEOPHYSICAL WELL# ❑ SOIL NORRIG 4 O IJ DESTRUCTION: S INTENDED USE TYPE OF WELL CON6TPU;iION SPECIFICATIONS ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION 11 A ❑ DOMESTICA'NVATE 91 GRAVEL PACK/SIZE DIA.OF CONDUCTOR CASING n/a D TYPE OF CARING/ST ALTVC_sc}1 40 mr- DIA,OF WELL CASING 27 ❑ PUIGATIONIAGPAL IJ DRIVEN DEPTH OF GROUT SEAL CIo UA O ❑ IRPIOATIONIAD ❑OTHEP y.,�� SPECIFICATION 1�� R JT GROUT PEAL INSTALLED BY LrIMiC GROW BRAND NAME yyyyyl itC .# MONITORING 201,1, 751 GROUT SEAL PUMPED:BJ Ys [I N. CONCRETE PEDESTAL BY DRILLER:❑Yw ®Ne 5 APPROX.DEPTH HOCKING CHESTER BO%/STOVE RPE PROPOSED CONSTRUCTIONANBLLINO METHOD: MUD RO ARyS AIR R ROTARY AUGER CABLE OTHER 1 REGULATIONS CERTIFY THAT I HAVE PREPARED THIS OME 0 O Ell CANT THE WOPK WILL BE GONE IN ACCORDANCE WITH DAN JOADUIN COUNTY OIiDINANCEB,STATE LAWS,AND RULED All REGVIATIONe OF THE SAN JOAQUIN COV7 HOME O ER OR LICENSED AGENT'S SIGNATURE CEITTIFIE6 THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH TI/16 PERMIT IS ISSUED,I DIIALL NOT"MRO RBONS S EJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR OUR COMPACTING SIGNATURE CERTIFIER THE FOLLOWING: •1 CERTIFY THAT IN TI RFORMAN OF THE WORK FOR WHICH THIS PERMIT IP ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN9 COMPENSATION"We OF CALIFORNIA.' APPLICANT UST C �T4 mme IN OVANCE FOR ALL REGURFG 1 RECTIONe 1]oel AgJLL E COMPETE DRAWING AT LOWER AREA PROVIDED. COMPENSATION slit/ B% , TRI D.I. OF PAN IDrew to S, Bpels •tp 1. NAMES OF STREETS OR ROADS NEAREST TO OR NOUN IND THE POOPERry. Z. OUTLINE OF THE mGPEmY,GIVING DIMENSIONS ANO IOBTH DIRECTION. #. LOCATION OF HOUSE SEWAGE DISPOSAL DYBTFM OB PIGMSED 3. DIMENSIONED OUTLINE.#ANO LOCATION OF ALL EXIST IG AND Ffloveno EXPANSION OF SEWAGE DISPOSAL SYSTEMS. STRUCTURES,INCLUDING COVERED AREAS Well ADP)TIOS,DRIVEWAYS,AND WALKS. E. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNOREG FlFry R. ON THE PROPERTY OR ADJOINING PROPERTY, DEPARTMENT UBE ONLY Appllvtllen Avaapled BY OrpN Impeclb 8Y Dele1��, � Ara •� vY / Dete %enp Inepeellen By Omnuellen Imn.etlee,P,v. �D� - Uu. 9 X13/ s ACCOUNTING ONLY: AID/ FAC# PE CODE# FEE INFO AMOUNT REMITTED CHECK//Cgel/ PECTD-V—ED SY DATE IEMGTISFgNCE gEOUESTUHBFq H INVOICE Pub.Health Serv.-Enviro.173(3/96)