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SAIMPPLICATION FOR WELL/PUMP PERM AQUIN COUNTY PUBLIC HEALTH SEES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209)468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (rom late In viel APPLICATION 19 HEAE By MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT IANODIOD{IINSTALL THE VIOIEL DESCRIBED.THIS APPLICATION 19 MADE IN COMPLIANCE MH SAN JOAQUIN COUNTY DEVELOPMENT TTTIE,CHAPTER 8-1116.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRE9SIOR APNE 74 Linco n enter CITY_S D k onseward way approx l,I' icksbur Pl. Set in ll �1ea Tn Defendents (SDCDs * l S 2 �AIOEL""8'fpH�{ g OWNER'{NAME cfo ITon2gl.d Brad',h w Levine-Fricke RecoTAooREae Emenrylilel 7` '44 OD by jor ,g-652-4500 CONTRACTOR ADDRESS 99 UCI PHONE{ ava coNrgncTOR_ Gregg In-Situ Inc ADDRESS Ma�tinez RCAd945 3 510-313-5800 Uc#CA-(.SFi4m RHONE TYPE OF WELLARIMP• ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL I ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS CONNECT REPAIR ❑ VAPOR EXTRACTION WELL E ❑New❑ J Repnr N,P. DEPTH PUMP 8FT FT. FIRST WATER LEVEL HYPE OF PUMP) __ O 11 ❑ DVT-0FeERVICE WELL ❑DESTRUCTION: GEOPHYSICAL WELL ® SOIL BORING S IgE=Use TYPE OF WELLCONSTRUCTION SPECIFICATION{ ❑ INDUSTRIAL 11 OPEN BOTTOMA OIA.OFWELLEXCAVATION 2-inches DIA.OF CONDUCTOR CASINO N/A D ❑ DOME9TIOAWVpTE 11 GRAVEL PACKIM2E TYPE OF CASINGMTEEUPVC N/A DIA.OF WELL CASING N/A O ❑ PIBLICRJUNICRPAL ❑DRIVEN DEPTH OF GROUT SEAL Tntal PPnth SPECIFICATION_ (•omen ❑ IRRIGATWNIAO 11 OTHER OROUTSEALINSTALLEDBY Contractor 'te R 1:1MONITORING GROW BRAND NAME_ N/A E PROPOSEDERH SEAL 80 feet GROWPIMPED: ®Y. [IN. CONCRETEPEDESTAL B ❑ YORMOR: y. [IN. a LO( IVIG CHESTER BOX/WOVE RPE N/A R10P0{FD CON{TgVCTONIDI{WNQ METHOD: MUG ROTARY AIR ROTAIP S AUGER CABLE OTHER HVdrallliC Push 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ANO THAT THE WORH WILL BE DONE"o ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND RULES AND REGULATIONS OF THE BAN JOAQUIN COUNTCERTIFIES THE FOLLOWING:•1 CEII IFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PERFAP IS ISSUED,I WALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'{COMPENSATION LAWS OF CALIFORMA,• CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WOW:FOR WHICH THIS pERMP IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORIOHAN'{COMPENSATION LAWS OF CALIFORNIA.' THF A/y,L�ANT MU{T CALL XA HOUR/IN ADVANCE FOR ALL REQUIRED M{PEOTION{AT IMI 4{{JMXJ, COMPLETE DRAWING AT LOWER AREA PROVIDED, SIIx dC�� TRI. Site Project Manager Do„ 6/J7-47 PLOT MN Mrow to S&,o)III 'le 1, NAMED OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY, 2, OIIyLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION, A, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM on PROPOSED 3, DIMENSIONED OUTLINES AND LOCATION OF AIA.EXISTING AND PROPOSEDEXPANSION OF SEWAGE DIGMBAL SYSTEMS. GTRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WAMS. {. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON THE PROPERTY OR ADJOINING P opERTy, PB 1 -202 ✓� - '� Jai 4 } 000 W I y O I ; R 6 P ' / i 1 M L: :A- VILLAGE 1 CLEANERS '\'• S� ; —LVVMD 1#2 i' 7 Z0z- LOT-4v. l000m000toot I � v L I 1 >%'� MW4 �I Court: n fined in the First Final Consent Decree Ord iNT&T o rand Reference to Special Master, filed with the ......... Court on Januar 1,, 9�D96; Section IV, Paragraph G. �� nnnne.Inn Aeeeptd e� Y N /f �Cc Gel• Ar.. GroU lmpevlNn BY Dns RXnP Irnpee0en ey Due beebmtbn Irwnaolion By D.te DemmenH.: ,�G �riGY'o�chrnv,y1 -Per.-n L�' 9 — 2 z 40—W eX Fj kyS �b l5 5�-• ACCOUNTING ONLY: AIDE' FACT PE CODES FEE INFO AMOUNT REMITTED CHECKIX;A{H RECEIVED BY GATE P9MITISEMCE REQUEST Ntwelm INVOICE Pub.Health Sew.-Enviro.173(1/97)