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APPLICATION FOR WELLIPUMP PERMIT SAA! JOAQUIN COUNTY PUBLIC HEALTH SERI-_rS ENVIRONMENTAL HEALTH DIVISION P'O' BOX 388, 3U4 EAST WEBER AVENUE, STOCKTON, CA Mmi- 88 (2091468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED (Compl&te In Triplicate) APPLICATION 16 HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WORK DESCRIBED,THIS APPLICATION IS MADE IN COMPLIANCE WfTH SAI JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION, i JOB ADDRESS/OR APNN 10480 N Highway 99 MIN Tower) CITY Stockton 086-070-34 PARCEL 81XElAPNN OWNER'SNAME Sliverado Broadcasting ADDRESS 6820 Paciflc Avenue #200 Stockton, oNE� 209 476 1230 CONTRACTOR Earthtec, Ltd ADDRESS 1830 Vernon Street #7 RB�WvIIIe, PHDNEV 6 786 5262 SUB CONTRACTOR - ADDRESS LIC/ 408595 PHONE 4 TYPE OF WELLnVMP: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONrronma WELL R © OTHER GEOTECHNICAL SOIL 3OR I"NG ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL# (TYPE OF PUMPI 13 Now 11Reparr H.P. DEPTH PUMP SET FT, FIRST WATER LEVEL C ❑ PUT-OF-SERVICE WELL ❑ GEOPHYSICAL WELLS SOIL BORING g ❑DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS _ A ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION DIA.OF CONOUCOi(CASING p ❑ OOMESTtctmVATE ❑GRAVEL PA I CKlB ZE TYPE OF CASINGlSTEELlPVC DIA.OF WE CASINO 'l p 11PUBLIC/MUHICIPAL ❑tt��bWVEN DEPTH OF GROUT SEAL SPECIFIC A .ON R 11IRRtGATIONIAG QOTHER GROUT SEAL INSTALLED BY GROUT B ND NAME 'z u 1 r S E ❑ MONITORING GROUT SEAL PUMPED: ❑Yee ❑He CONCRETE DESTAL BY DRILLER:❑Yee 44 o s APPROX.DEPTHApprOX_501 LOCKING CHESTER BOXISTOVE PIPE �. _ s 7:j PROPOSED CON&TRUCTIONtDRILUNO METHOD: MUD ROTARY AIR ROTARY AUGER_ _CABLEL OTHER I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORT.WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES ANE REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AOENT'B SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICF THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'&COMPENSATION LAWS OF CALIFORNIA CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIEL THE FOLLOWING: 'I CERTIFY THAT IN THE PERFORMANCE OF-THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS 01 CALIFORNIA.' THE APPLICANT MUST CALL 24 HOURS 1N ADVANCE POR ALL REQUIRED INSPECTION&AT 12001468-3422. COMPLETE DRAWING AT LOWER AREA PROVIDED. t Started x1 _TMs Pr 1 nnc i a I Consultant P Date 6/15/00 PLOT PLAN(Drew to Soele)Seala to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY Ft. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS, ON THE PROPERTY OR ADJOINING PROPERTY. .., .. SEE-ATTACHED.NEAP.. _ ..,.., GEOTECHNICAL ONLY RCS EQUIPMENT 10Ex 14' LEASE AREA , vn as atltwae r/s PROW w.a ae::.w larw w� . f>0,>MC�aetlt IL_JI ;RE / �UN�y 0\�A . con" ma,aR NOTE: SPN 1�A�P�ZN�� p1�15�0� LOCATION OF ELECTRICAL AND TELEPKONE SUB.IE PACIFIC SELL RING EN��RflN APN: 086-070-34 NO CHE 1CAL TESTING ,su PGCE TETRA TSC. WIRELESS 136-C 'IN TOWER i XHiBiT B a'=m 0561 06+�iOx u ii DRAFT NOT TO$CAME f "dam. ;� -— .... —,'r:— t��', +�•'+��''�1N,'yN"�`yK:.� _ ,...�...... � DEPARTMENT USE ONLY t Applicetlan AocepteA By IJ L bete_ 00 Arae Com^1 Grout Imp tlon B Deta 7-U(�Pump(n4pectlan By Date Deetruetion Impaction By Date ' Cammenle: I' . ACCOUNTING ONLY: AIDN FACR PE CODES FEE INFO AMOUNT REMITTED CHECKi'JCASH AECIIVED BY D TE PEAMITf&ERVICE REQUEST NUMBER INVOICE