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- ig o b vs® APPLICATION FOR WELLIPUMP PERMIT pp SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES Y 'Ile ENVIRONMENTAL HEALTH DIVISION 3 r+^{ P.O.BOX 388,904 EAST WEBER AVENUE,STOCKTON.CA SMI-388 4", (2091480-3420 Z t7� 1 ` NOWNUUMDARLE PERMn EXPIRE!I YEAR FROM DATE 133UED —IV,n Ic.."1 (Umpbte M Triplicate) APPLICATION IS HEA E BY MADE TO THE SAN JOAOUIN COUNTY FOR A PEWArr TO CONSTRUCT ANGORA INSTALLTHE MM DESCRIBED.THIS APPLICATION A MADE IN CJIAPLIANCE WITH BAN JOAOUIN COL44TY DEVELOPMENT TITLE,CHAPTER 9-1110.3 AND THE STANOAIOS OF SAN JOAQUIN COUNTY PUBLIC HEALTH BERVICEN,ETMRONMENTAL HEALTH OPliSION. JOB ADORSB,OR..PN/_ 24801 S. L a RI Rl e r s Rd. cm Tracy PARCEL NZFJAPf/ OWNW-INAME_E-Lnest Ponbc. Jr. ADDREp6 P.O. Box. 805 Tracy, Ca NODNEF 835-4949 CONTRACTOR Hennings Bros. Drilling Co., Inc. AGDREBB3525 Pelandale Mod x,290813 w,E, 545-1185 BUB CONTRACTOR ADDRESS LIC/-! P40W 6 TYPE OF 1NELLRLIMP. ,P_A NEW WELL ❑REPLACEMENT WELL ❑MONITORINo WELL F ❑OTHER ❑INSTALLATION ❑WELL SYSTEM REPAIR ❑CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL/ J ❑Nw❑RI...I. N.I. DEPTH PDw pET_FT. FIRST WAT'_R LEVFL O fTYPE OF PUMP) ❑OUT-OF-SERVICE WELL ❑ GEOPHYSICAL WELL/ ❑ SOIL BORING IT ❑OESTPVCTION �- SII �INTERDTD OF W CONSTRUCTION IFICATIO A USTr ❑yy INDRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION 1 2 II ORA.OF CONDUCTOR CASING O ,4,A DOMESTICIIEWATE ®GRAVEL PACIUNZE TYPE Of CASINWITtEELI VC_ PVC DIA_OF WELL CASINO 6 II D ❑PUBUCIMUNLCIPAL ❑DRIVEN DEPTH OF GROUT BEAL 100, _ SPECIFICATION Bentonite w i^ ❑WAGATIONIAG ❑OTHER GROUT SEAL OMWED H e n n F n Q OPIOIrr BRAND NAME E ❑MONSTOWNO 0 �, GROUT BEK PUMPED:�L,pYr ❑N. CONCRETE PEDESTAL BY ORILLETL•❑Yr NP S RO APFX.DWTM 2 V Q I LOCKING CHESTER SOXISTOVE PIR S PROPOSED CONSTFLCTIONIDRILORIG METIq D: AR/D ROTAS X X AIR FOTAM AUGER CARIE OTHER I NEYBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TEAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAH JOAQUIN COUNTY 01OINANCE6,STAR IAVVB.AND RULES A1q REOULATIDNS OF THE SAN JOAOUIN COUNTY.HOME OWNER OR LIC111WO AOENT'S 610NATURE CERTIFIES THE'OLLDWINO:'1 CERTIFY THAT IN THE FFI FORMLI ANCE OF THE WOISC POWHICH THIS PERMIT IS ASUED,I WIALL NOT EMPLOY PERSONS SUBJECT TO WOhYfMAN'S COMPFIAATIOR LAWS OF CA:iOIMIIA.' CONTRACTOR'S HIRING OR SUp-CONTRACTING SIGNATURE CERTgE THE FOLLOWING: '1 CEKT"THAT IN THE Pff"AMANCE OF THE WORK FOR VABCH TENS PERART 16 SSUEO,I MALL EMROY PEF IONS SURIECT TO WORKMAN'S 00RM6AATION LAWS OF CAUPORMIA' THIS APPLICANT MUST CALL H NDLRIS\1.AMINCE FOR ALL F1ID.W IN•SWIOTIOR`S,AT WISS 440 AT COM DRAWING AT LOWER AREA PROVIDED, St.X 3..nlm Yom-•e t� r.�-_1 l i a 4�....-, �,4 - [X.4 L�._...7 �-;—fl'�,LC,I DRI. 3-2 8-9 7 PLOT RAN ID—t.Sew)a.Pl. I. o I. NAME$OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. - A. LOCATION OF HOUK SEWAGE DISPOSAL SYSTEM OR PROPOSED 2.OUTLINE OF THE"MPFATY,GIVING DIMOMON1 AND NORTH DIRECTION. EXPANSION OF SEWAGE d4OSAL SYSTEMS. 3.DIMENSIONED OUILINFJI HOD LOCATION OF ALL EXI.IKO AHD PRDPO6ED S. LOCATION OF WELLS WRMN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,NCLUDINO COVERED AEIEAG SUCH M PATIOS.DRIVEWAYS,AND WALXR,- ON THE PROPERTY OR ADJOMMIO FEIDPEKTY• c� C.J r»as •. :. F G ��D�r, LLrJI . • . X i * 'APR 1:1997 aa I"EAC 248D! TIO Se.Ttl or F 11*I Sr r� _ vv +Vp+u L': ihALTH WkfF SI S r ...:., ' ( 1 y DEPARTMENT USE ONLY ,E 1 A.11-l n Ae..PRM NY1 .. D.1. Oro.c Inrrtbn pY / D.ReT I- Rmp Ir.p.ptbn SY D.I. C--`-:—116� .A.fa+ur=� AL{I � 9TV ACCO'JNT1NO ONLY:V HD/ FAC/ PZ COD" PEE INFO AMOLMY RS.aTTED CIIECKPRASH RECEIVED BY DATE ps"TISOVACE T N INVOICE 4 1 o 10.00 X37 0 D3