FIELD DOCUMENTS_1997 - Laserfiche WebLink

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afiPPLICATION FOR WELL/PUMP PERM SA AQUIN COUNTY PUBLIC HEALTH SEES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209)468-3420 NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED hAPPLICATION IB HERE BY MADE TO THE CAN JOAQUIN COUNTY FOR A PERMIT TO CONSTTRUCTANOMR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WHIZ BAN MAGOON COUNTY DEVELOPMENT TITLE,CHAPTER 8-1116.3 AND THE STANDARDS OF BAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSAOa APR# cm Stockton Cameron Way approx 3851 W of Settl ng Dry Caning a en en s s PARCELSIZEAPN# Gettysburg P1. OWNER'6NAME c/o Donald Ty. Bradshaw Levine-Fricke-Seco 1900 Pgwe 11 gt, 112pth gloor 510-652-4500 gLDDREee Emeryville, .CA X4608-1827 Y'I510- CONTRACTOR ADDRESS Bowe oa �# PHONE We CONTRACTOR Gregg In-Situ, Inc. RE 0 AnDMSB am rtlnez, CA 94553 �# X510-313-5800 TYPE OF WELVPUMP• ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL I ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL# ❑ HYPE OF PUMPI New 11ReP* N.P. DEPTH PUMP SET FT. FIRST WATER LEVEL o 1:3 OUT-OF-SERVICEWELL ❑ GEOPHYSICAL WELL# 13 BOIL BORING B ❑ DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS ❑ INDUSTRIAL ❑OPEN BOTTOMA ❑ DIA.OF WELL EXCAVATION_ ?-inches DIA.OF CONDUCTOR CASINO N/A D DOMESTIOMIVATE DRAWL PACT/SIZE TYPE OF CASINOMITEEUPVC N/A NA.OF WELL CASINO N/A D ❑ PUBUC/MVNICIPAL ❑DRIVEN DEPTH OF GROUT BEAL ',)•Otal Depth SPECIFDATION Cement-Bentonite ❑ IIE NGATION/AG ❑OTHER GROUT REAL INSTALLED BY (:OntYaf•tpr GROW BMW NAME❑ N/A E MONITORING GROUT SEAL PUMPED: ®Ys ON. CONCM1EPEDE8TQBYDRILLER:13yw [IN. e APPROX.DEPTH 80 feet LOCKING CHESTER BOX/WOVE PPE N/A s PROroSFD CONSTRUCTONIDItlLLINO METHOD: MVD ROTARY AIR ROTARY AUGER CABLE OTHER Hydraulic Push 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS OF THE BAN JOAQUIN COUNTY, HOME OWNER OR LICENSED AGENT'S BIANATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WNICH THIS PERMIT IB ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CMNOPMA.' CONTRACTOR'S RISING OR BUB-CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: -I CERTIFY THAT IN TIIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE ANT MUCT CALL 24 HOURS IN ADVANCE FOR ALL REOMED INSMCTMNS AT 1208 ASSOA21. COMPLETE DRAWING AT LOWER AREA PILONDEO. Tlne Site Project Manager One 6/197 PLOT PLAN 0.t.Bowel&.I. •to I. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE RDPERTY. 1, ROGATION OF HOUSE SEWAGE OIBroBAI SYSTEM OR PDroBEb 2. OUTLINE OF THE PROPERTY,OIWNO DIMENSIONS AND NORTH DIRECTION. EXPANSIONCATION OF SEUSE S DISPOSAL SYSTEMS, 3. DIMENSIONED OUTUNF.E AND LCCATDN OF ALL EXISTING AM PROPOSED t. LOCATION OF WMA WITHIN MRAOS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUMNO COVERED AREAE SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE LOCATION M OR ADJOINING RIS OF O'. 1 L ✓� , _ SGPT -� r PBI -202 -202 'kA ( pP 1 n VILLAGE% W' CLEANERS r y t MW-7 PRS L _ CVMD #2 eF , ` 1 'MW I \VLIn &1 *SDCD: Defined in the First Final Consent Decree 0&4WTARAVq @q& and Reference to Special Master, filed with the n99Le�bnA.n.4 996; Section Iv, paragraph G. O Dete_ A My Oreu1 Impxebn BY Dete pump Impeetlen By pea Owt.mtbn Imneedon By ,1� Dete Lemmd.U: G-1'l' �LYIC.✓'GYLcI'l V►�..QI� 1 2✓,n l 92Z-ZL LP # ZIP ACCOUN11N0 ONLY: AID# FAC# PE CODES FEE INTO AMOUNT REMITTED CHECIUFMASH RECEIVED BY DATE PERMIT/SERVICE REQUEST NUMBER INVOICE 7-q D18 2 .41344 IZa Pub,Health Sew.-Enviro.173(1/97)