FIELD DOCUMENTS_1997 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR WELLIPUMP PERMIT SAN JOAOUIN COUNTY PUBLIC HEALTH SER ENVIRONMENTAL HEALTH DIVISION P.O. BOX 988, am EAST WEBER AVENUE, STOCKTON, CA 95201388 (209) 409-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM BATE ISSUED ICampIBLB In TraOeBbl APPLICATION IB HERE BY MADE TO THE SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDIOR INSTALL THE WOW DESCRIBED.THIS APPLICATION 16 MADE IN COMPLIANCE WITH SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 8-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSOR APN# 374 Lincoln Center clrY Stockton PAMELBIZE/AM# 097-41-79 Settling Dry Cleaning Defendants (SDCDs*) 1900 Powell St. OWNER'S NAME„/,. n ..,.i aCA-9 699 927 PHONE#510-652-4500 COMRACTOR ADDRESS UC# PHONE 0- SUBCONTRACTOR Weeks Drilling ADDRESS Sebastopol uc#C57-177681 PHoNEP707-823-3184 TYPE OF WELLA'UMP: ❑NEW WELL ❑ REPLACEMENT WELL ® MONROMNa WELL# ® OTHER Pilot boring 44�3 ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL I J (IYPE OF PVMPI 11N.❑Repel, N.P. DEPTH PUMP BET FT. FIRST WATER LEVER O ❑ OUT OF SERVICE WELL ❑ GEOPHYSICAL WELL# ❑ BOIL BORING a ❑DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION BPECOICATIONO A ❑ INDUSTRIAL 11 OPEN BOTTOM DIA.OF WELL EXCAVATIONI6 Inch DIA.OF CONDUCTOR CASING 16 inch O ❑ DOMESTICVPRIVATE 9GRAVEL PACK/SIZE TYPE OF CASING/6TEEl/PVC St061 DIA.OF WELL CASING n�}REIT D ❑ PUBUC/MVNICIPAL 13 DRIVEN UEPTHOFGROUTSEAt 7--3C' LgCj SPECIFICATION Cement-bentonite R ❑ IRRIGATIONIAG ❑OTHER GROUT SEAL INSTALLED BY driller BMW BRAND NAME E 10 MONITORING GROUT SEAL PUMPED:®Ys [IN. CONCRETE PEDESTAL SY DRILLER:®Yr ON. S APPROX.DEPTH 140 feet _ LOCKING CHESTER BOX/mDVE PPE_ S PROPOSED CONSTRIMTION/DFULUNO METHOD: MVD MTAIIY�_AIR ROTARY AUGER CABLE OTHER I LII:2I1 i ,.l — 3 cuas I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPUCA ION AND THAT THE WOPC WILL BE DONE IN ACCORDANCE WITN BAN JOADUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND MOULATIONS OF THE SAN"AMIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED.1 SIRALL HOT EMP.OYPERSONB SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA-- COMPACTOR'S HIMNO OR BUR-0OMMCTING SIGNATURE CERTIFIES THE FOLLOWING: •I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPMBATION LAWS OF CALIFORNIA.' THE APPJCANT MUST CALL 24 HODU IN ADVANCE FOR ALL MOUIRED INSPECTIONS AT 12001 400 34 2 2. COMPLETE DRAWING AT LOWER AREA Pro VIDEO. SlOmdX �`�41_ ) TIO• Site Project Manager —T PLOT PUN(Drµw SaY•I BONS •Ie 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PR01'FRTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR MoMLOED 2. OMUNE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISTOBAL BYSTEME. 2. DIMENSIONED OUTUMS AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING MMM. A. R�,cE y.._ A/CP7 MWS LVMD M2 14 2Y ��._�I) !/1 C LVMD#1 MW4 I0�X0[I�VTELX MW20 �[dyA3 C LVMD 46 " ag LIN.L.•ICMC DEMI W3 scxa '. MW7 6 MW i MW6 MWI 21 Fmmu Not p �'L MW 2 amR MW9 cicn6 Villag Ly Forma 8mm z Cart Cicaners G �E 1 �) m 4 $ .@ MWII MWIOA / A/CPC Y Chevron Rµ Gas$Iellne ri C p9FS1� 'o MW3Y MW l MWb YPLL MA�1 E1Fnn('id3$1]IIOn s e Lne Tn a Lrs ina onsen Scree r er Juagement and ReferennGo pecia as er, MeV.4H fRe court on January 18,�19�9H.6:,.Section HIV, Paragraph G D"MTMMT USE ONLY �yY ApWIwIX,AmepleA BY /TL.CLL'I\/ 1 D.I•_ '� / Aru Grein Impmtlon By OHe Pune Impmllen By Dtls DeevwOen Imnmaon By D.Ie Demma,I.: AEmeR-1�c/.t-La� b1a- I.Incn►h �nl�^r�A [Qg�1.P Col�nfU 55 53 evi ( Co ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMOUNT/EMITTED CHECK#ICASH RECEIVED BY DATE PSWIT/BERVWE REOUEBT NUMBER INVOICE 2Ci0 22 5'S. b12N