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4-23-1997 3:46PM FROM P_ 2 E APPLICATION FOR WELLJPUMP PERM'• • SAN JOAQUIN COUNTY PUBLIC HEALTH SERwit;Es ENVIRONMENTAL HEALTH DIVISION B 804 FAST WEBER AVENUE. STOCKTON. CAS (209) 468-WO 3-�b 'I S--4-:2) 7�2— NON-REFUND49LE PERM PITIES I YEAR IFWOM DATE ISSUED (Complae YI Tdp4mul - APPLICATION N MERE EL MADE TO TME VAN JOAQUIN COUNTY FOA A pQgyrT TO CONSTRUCT ANDtoq INSTALL THE WORT(OEtICWSEO_THIS APPLICATION Ia MASE W coMT+Vy10E y,R•R/ •IOAGUM COUNTY DEVELOPMENT TRIS.CHAPTER 8-1115.3 AND TME STANDAMS OF SAN JOAOUIN COUNTY PUOLIC MEALTH SERVICES.plWIIS APCNMENONI NEKTM DNIBION. JosAooREvmp:A#Ni 1444 South Lincoln Street Cry Stockton P^WCFL9IzFJAPN# N/A OWN01.8 NAME Metz Baking Company ,� E1014 Nebraska St. ,Sioux City,IA 712-23 NE r CONTRACTOR THF Drilling, Inc. A00TTEii9431 Resenda Ave 05 t)c� PMONE• Z on ana, 11 eve CONTRACTOR ADaPIESs UC#C 5 7-5 0 5- "�7��PHONE 1 TYPE OF NEW WELL ❑ RERACEMENT WELL ❑ MOWTORMO WELL r ❑ o'rmm-Cone Ppnetrometer test- Cl INSTALLATION ❑ WELL SYSTEM RE9AIR Cl CmSS.CONNECT REPAIRV ing points ❑ APpR EDCTRACTbN WEty# (TYPE OF PUMP) ❑N.+❑AYaM M-P- DEPTH RIMP OFr .FT. FIRRT WATER LFVEL ❑ OUTOfL'Su ICE WELL ❑ GE-OPNYX C16L WELL r ❑ BOIL BOWNG ❑DESTRUCTIoN• INTFIIDED UCE TVP!OF trF�„L CoodsTRucTION S!!wPICATIONs ❑ MIODUTNAL ❑OPEN BOTTOM DIA_OF WELL EXCAVATION DIA.OF CONDUCTOR CAaINp ❑ DOMEBTICRRVATE ❑GRAVEL PACLVSiZE- TYPE OF CASING/s•TlPeJPVC DIA.OF WELL CASINO ❑ FUBLICMUNICIPAL ❑DRIVEN OEPrH OF GROUT SEAL SPECIFICATION 13 MW0ATIOH/AG 00THFA GROUT SEAL INSTALLED BY tUAoUT BRAND NAME 0 MOMTOWNO GROUT SEK PUMPED; 0 Ya. ❑N. CONCRETE PEDESTAL BY 4PyLLER:I]Y— [31A. APPROX.DVTI4 -125—f loas LOCXMLO cMEer ER BO:RITOVE PIPE PROP0@W COMiTRUCTIONn=LU"G METHOD! MVO ROTARY AIR ROTARY AUGER CABLE OTHER 1 HEEBY CERTIFY THAT 1 HAVE PREPARED TRM AwUCAT1ON ANp THAT TME WORK WILL M DONE IN ACCORDANCE WrTH SAN JOAWW COUNTY OSDINANCE9.ITrAYE LAWS,AND RULES F"X ATIONS OF THE SAS.JOAQUIN COUNTY. HOME oWNM OR UCENREO AGENT'■SIGNATURE CERTIFIES TME FOLLOWING;I CERTIFY THAT IN THE PERFORMANCE OF THE WQFw.FOR WM THIS PERMIT IS ISSUED.I SNAL•L NOT El A&KaY PERSONS sUOJECT TO WOMMAN's COMPt&SATION LAWS Of C•UPORNIA.' CONTRACTpR•S HIRING OR 9uaCONTRACTINa SIGNATURE CERTII THE FDt10YNNG- 1 CERTIFY TRAY p!THE PlRRORIMANCE OF THE WOW FOR WHICH THIS PEmAR IS jsmAO.1 sHALL oajoY PERaOMs suRJECT TO troRla.1AN'S COM►F7+aATIa Uwe cAUFORMA. APPLWJ N� -6i W.ME MOtIRS W A WAANCt FOR ALL REOWRIM tII�IMTgNR AT mmi 4s-ma=, COMPLETE DRAWING AT LOWER AREA PROVIDED. g4r�X "r `(� f 1 T I i t TIO. i r +yy-( (r G v l+ r - PLOT PLAN IDn w t.R.W.I 9a./. 1. NAMES OF STREETS OR RpAoi NEAREST TO OR BOUNOWO THE PROPERIy, 4. LOCATION OF HOUSE SEWAGE OICPONAL.SYE•rFm Oa PftOP06Ea _• OUTLINE OF THE PROPERTY,GANG DIMENSIONS AND WHUM OWCTIDN. EXPANSION OF SEWAGE DIAPOSAL SYSTEMS_ ]• DIMENVONED OUTLNEs ANO LOCATION OF Aly EXISTMG AND PROPpsm ES, LOCATION OF WELLS WTTINN RADIUS OF ONE MUNOIWO FIFTY FT. tfRUCTVRE3•MICLUDh+IO COVERED AftfJ►i SUCH AS Pw7q S,DRIVEWAYS.AND WALKS. 6. THE PROPERTY OR•OJoIMING pMpE.RT/. .. ..:...... ....:..... Site....1 n...inelu ded ..in at 1 ....'... ...i.. ....4....i.... ..i.. ........ .. .• .. ..... .+.. ♦ , .. ...'... ./ .. ' .. .. ...... ...... • ..i.. ... .l... .... ..:.....i........................................ .....i..... i ! .....n..... ...... .. .. .. ....... .. ........:......j................. ......}......�........... ., • S . ' , .:.... . .... ...T. .....o .. .j.. .0 ... .J.....................: ...a......:......o. ...:. .. .. ................ DEPAICTMEMT UM ONLY APPMaclan Aa.wr.d B• D.t. Gran}Ir.p.retl.n BY 304 oat. Fun p 4-pmtlan DY D�� D.rtrlA:tbn Ir..ImHa..B. oat.Car.narrtr, wCCOUNTTRG ONLY; MD# PAC# R CODES FEE INFO AMOUNT RBMITTEO cHrer tic"ll "CRVED SY DATE P9MIT/SOWl"ROCILRAT MILWISR INVOICE Ll 0k 4q LS