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APPLICATION FOR WELL/PUMP PERMIT <br /> ;AN JOAQUIN COUNTY PUBLIC HEALTH SER' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ` 1506 304 EAST WEBER AVENUE. STOCKI'ON, CAS <br /> (209) 4603420 b <br /> NON-REFUNDABLE PERM PIRES 1 YEAR FROM DATE ISSUED <br /> APPLICATION Is+IE11EBY NAGE TO THE CAN JOAQUIN COUNTY FORA POWIT TO O�nNSTRUCTpbra AMDT /O�q INSTALL THE WIDOW DESCRIBED_THIS APPLICATION IS MADE W COMPV^ <br /> JOAQUIN COUNTY DEVFEDPMEFJT TTTU,CHAPTEm 9-1116.3 AMHE D TSTAMDATbB OF SAM JOAOUIN COUNTY PUBLJC HEALTH SERVICES.ENVIRONMENTAL HEALTH M nWOM_ ���6• <br /> JOB ADORERs oR APM/ 1444 .SmIth l i n c n l n Street CITY Stockton PARCEL 9IZEJAPNr <br /> OWNEA•B NAME_ Ed Overton ADDRESS Frenccll am CA 95231 <br /> PHONE r 90c) ZICIZ, <br /> CONTRACTOR_ GreggDrilling 1 i n Tn-Si to 5 �OWz R ue.4 .65 <br /> g AooRRE lart�nez, 9 +553 PrIDNE r510-313 <br /> BUB CONTRACTOR A[IOFRESB MR `�6— <br /> PHONE 1 <br /> TYPE OF W%LSRJM" ❑ Ww VAgL ❑ RFfLACEMENT WELL ❑ MoMITORMO mftx r ] OTHER 'P T c� H V d r o u n c h <br /> ❑ wwrALLATIOM ❑ wE71 SYETEM REPAIR ❑ CROSSCONNECT REPAIR p VAPOR EXTRACTIOM WgU r <br /> RYPE OF PUMPI <br /> 13 Mw.13 mR Rw Np_ DEPTH PUMP . FRSf wATEA LEVEL . <br /> 13OU•TOFsumcE wELL 13GEOPHYSICAL WERI <br /> LL r D BOR.BONG <br /> ❑DERrTRUCTbN• <br /> INTENDED USE TVP!Of W" CONSTRUCTION SP1oCIRLATIOMS <br /> µouSTRIAL ❑OP}M BOTTOM MA.OF WELL EXCAVATION DIA.OP CONDUCTOR CAaWM L <br /> ❑ DOMEMI—VRIVATE ❑GRAVEL PACK/SIZE TYOE OF CAVNGffrffX/PVC DIA.OF WELL CASING <br /> ❑ PUBLIC/MUNICIPAL ❑DRIVEN OEVTH OF GROUT SEAL SPECIFICATION f <br /> ❑ MPAOATION/AG ❑OTM A GROUT 1;EKAL MBTALLID BY GROUT BRAND MAMIE f <br /> ❑ I+OXD <br /> ropime <br /> AP, s.DUPTH <br /> 125 f b g s L PIMGROUT SEAPED: ❑Y— ❑N. CONCI+ETE PEDESTAL 8Y DwLLER❑Y. ❑w <br /> H LOCKING CHESTER BOZwTOVE PW! J <br /> PROPOSED CONSTRUCTIONIMP UTMO MLRHOO: WO ROTARY AIR ROTARY AUGER CABLE OTHER k\ <br /> 1 HEREBY CEWrFY THAT 1 NAVE PREPARED THIS APPLICATION AMC THAT THE"PK WILL BE DOME IM ACCORDANCE WRH BAN JOAOUIN COUNTY ORDINANCES.STATE LAWS,AND RULES AN <br /> REGULATIONS OF THE BAN JOAQURN COUNTY. HOME OWNER OR LICENSED AGENT'l SIOMATURE CERIWES TWE FOLLOWMNO:y CEI"VY THAT IM TIRE PERFORMANCE OF THE WO(SL FOR wMlc <br /> THIS PERMIT Is ISSUED.I SMALL NOT EMPLOY PERSONS 9WECYTO WORSMAR't CQUIREIRSAT1oN LAWS Of GAUPORMA.' CONTRACTOR'S""No OR IwBCONTRACTINa BIOMATUf�CERRIFIE <br /> THE FOLLOWING: 'I CEPlTIFY THAT LM THE►lRFORASAAICE OF THE WONC FOR%YIHICH TMS POSAIT IS ISSUED.I SHALL 04"Y PERSONS RURIECT TO RroRIW1AR•S comPO,AATION LAWS C <br /> CALIFORMA.' TLRE AJw%JCAAIT MUST CALL:AS moLoz M ADVARR:E PORI ALL RCORaReo rM&r LTW)MB AT RBI)4"-Ss=, COMPLETE ORRAWI►NG AT LOWER AREA PROVIDED. <br /> m A h 19r : Titles Rgkk.+-- R viz., - D- <br /> t� <br /> IT <br /> T. NAMES OF STiM9 OR ROAD*NEAmsT TO OR BOUNOM THE PTOPERIY. �. LOCATION OF MDuaE SEWAGE MOPORAL SYSTEM OR RRbP06ED <br /> S. OUTLINE Of TME PADPERIY,GIVING OMuEMBgN6 AND NORTH OWC-tMm. EXPANIMOM OF SEWAGE DRSPOSAL SYSTEMS_ <br /> �• DIMENCIOMED OUTLINER AND LOCATION Of ALL EXIvTfMO AND PROPOSED S. LOCATION OF%A&-LLS WITHIN RAOIut OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES,INCLUDING COVERED AREAS OUCH AS PATIOS,DMWWAVS•AND wALILS. ON THE PROPERTY OR AOJOTMING PROPERTY, <br /> ...... .:.....:... • <br /> .:.............v....................:......o.... ...l... > ..v.. <br /> Y <br /> . ..........,. .5ite...V?14n...ind1uded •3 .. Woxk Plan dated 11/24/9.7_ , <br /> 'i <br /> .............,,.. ......... . <br /> .. .. . ;.....a. . .. , ..... s . ............. �.......;.... <br /> ...... . <br /> ... .. ..........I......;.. .. : . . <br /> ..i.. S ..a....i.. .j..... <br /> { .. ...A... ' I b.. i <br /> 3' .. .... ..}.... ... ... ....r <br /> . ............ .. ..........1 .r¢.... .. ....t....p.... ........•a.... . ...5... ....r.... .. <br /> ' ••e• ..Y• •C <br /> .s.......... .. ...e... ...i.. .. .i. .. .. .. i ..... ..1. .:.. •i <br /> T V T V�"yR II\f DEPIRYMFXT USi ONLY Z , <br /> APPFuclon Aoe+,d B. --- OSIS l ' �j I `1 <br /> Grout Irr.pmRlan BY Pir/tp 4+Rq.otlon BY D•q <br /> O..tw tat 1,.pmtls,B. oRtr. <br /> Ceww,tsgr, <br /> ACCOUNTTNO ONLY-, A000 PAC# <br /> Pi cobra FM INFO AMOUNT REAMTTED CHECC111CASH WEVED■y DATA P9014IITIOSPVIC2 REQUEST NUMBw INVOICE <br /> o --v <br />