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APPLICATION FOR WELLJPUMP PERMIT <br /> SAN JOACIUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NOR-REFURVAKE PERMIT EXPIRES I YEAR FROM OVE ISSUED <br /> (Complete In Triplicatel coply <br /> APPLICATION IS HIM BY MADE TO THEBAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AMMR INSTALL THE WOW DESCRIBED.THIS APKMAT�1$MAtAflHCOMKjANCfWQNUN <br /> JOAQUIN COUNTYMMOPMENT TITLE.CHAPTER 9-1115.3 AND THE VANOARCHI OF BAN"AMIN COUNTY PUBLIC HEALTH SIETMES.ENVIRONMENTAL M�M�MM. <br /> JOB ADOMINVOR APHO 3401 Whiskey Slough CITY Hol t PARCEIL SIZEENIVIN <br /> OWNEA-9 NAMEE_ WHISKEY SLOUGH HARBOR P.O. Box .107, Holt, 95234 Pmom, 942-4588 <br /> COMIUkCTOR NOACK W/o 19792 ADDRESS 4500 E Fremont Mf 504513 948-8817 <br /> -ST-o-cTton 95215 <br /> am CONTRACTOR AMANG8 UIC, I <br /> TyT%OFWEUJPUMP; ONewma 0 M�Eww wrtt. 0 MONVIONNO WELL IF 0 OTHER <br /> 0 INSTALLATION 0 WELL SYSTEM REPAIR 0 CMB�ONMCT REPAIR 0 VAPOR EXTRACTION WFU.0 J(,> <br /> Submersible []N.11 R,,oWl ".P� 1 HP DEPTH mmp a" 3 5 EMT WATER LEVEL a <br /> Rng"Mm%xisting pump OUT�F SERVICE WELL 0 GEOPHYSICAL�U-0 0 son.80MM <br /> 0 OfSTRIJCTION: <br /> INTEMEO USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A <br /> 0 INDUSTRIAL 0 OMN BOTTOM CIA.OF WELL EXCAVATION CIA.OF CONDUCTOR CASCM0 <br /> Xy DOMESTICIPRIVATE 0 GRAVEL PACKIS.Zf_ TYEf OF CASIMISTEIE� DIA.OF WELL CASINO <br /> 0 �WJCMUNICIPAL 0 DRIVEN OEM"OF GROUT BEAL SPECIFICATION <br /> • IFVVOA7ION/AO 1:1 OTHER GROUIT BEAL INSTALLED BY ORCHIT GRAND NAME E6 <br /> • MONITORING amw SEAL MMPFO: 0 Y. [IN. CONCRETE PEDESTAIL SYM%JUE":Ely. 13� 5 <br /> APPROX.DMH LOCKING CHESTER BONMOVE PIPE s <br /> PROMBW CONGTRUCTIOIMPILLING,METHOD: MUD POTARY_AIR ROTARY—AUGE11—CAIN1—OTHER <br /> I HE�BY CERTIFY 14AT 104AW PREPARED THIS�ATION AND THAT THE WORK WILI.BE DONE N ACCORDANCE WITH RAN"AMIN COUNTY ORDINANCE9,STATE LAWS,AND ROLE*AN <br /> MOULATIONS OF THE GAN JOAMN COUNTY. MME�A 09 LICENSED AGENT'S SIGNATURE CERTWIES THE FOLLOWING:'I CEFTT�THAT IN THE PERFORMANCE OF THE WOM Pon wHICN <br /> THIS PERMIT 18 IGSUFO.I SNALL HOT EMPLOY PERSONO MACY TO WORMAN't COMPENSATION LAWS Of CAUFORMIA.- CONTRAC�TOR'R HIRINO OR W�ONTRACTNO MNATUM CERTIRF9 <br /> THIEFOLLOWING' -I CERTIFY THAT N THE PERF'ORMANCE OF THEWOW PORWHICH THIS PERMIT 19 ISSUED.I SNAIJ.EMPLOY PEIVIONS SUBJECT TO WOPSMAN-6 COMPENSATION"We OF�, <br /> CALIFORNIA,' THE AMUST CALL 24 HOURS HI_&QYANC1 F0fl.!kL REQUIRED INSPECTIO T CZ01H 444*4". COM�%Eff DRAW040 AT LOWER AMA c— <br /> m'-i X_ 7122. Y�i 11 Dv. 24 <br /> 1. NAME@ OF STMETO OR ROADS NTAREBT TO On BOUNDING THE PBCIPFRTY� 4. LOCATION OF HOUSE AMAGE MIPUSM-SYMM On FTV)MGfD <br /> 2. OUDOW OF THE PSOPFRICY.IRVING DIMENSIONS AM NORTH DIMCMN. EXPANSION OF GEWAGE NOPOSAI.SYSTEM*. <br /> 3. DIMENSIONED OUTUNF8 AM LMATION OF ALL EXISTING ANO�POOEU S. LOCATION OF WELLS WFTEHN RAMS OF ONE HUMMD FIFTY FT <br /> STALICTURES.INCLUDING COVERED AREAS SUCH AG PATIO@,OVIVIVNAY9,AM WALK$. ON THE FMIMITIN'OR ADJ?01NM <br /> T� <br /> APR 15 1999 <br /> I UBUC HEALTH SEVICES <br /> ��'NVJ ONMENTALHEALTHoMS101 <br /> O"A"ry USE Ofty <br />