FIELD DOCUMENTS_1997 - Laserfiche WebLink

Home Browse Search

APPLICATI,IN FOR WFLLIPUMP PERMIT SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICO2 ENVIRONMENTAL HEALTH DIVISION RO. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201-388 1209) 46B 3420 NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete In Triplicate) APPLICATION IB HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOW DESCRIBED.TIRE APPLICATION 18 MADE IN COMPLIANCE WRIT BAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICF9a EW 0MTNME yAL HEALi%VVISITOJeNS t Of JOB ADDRESS/OR APNI 374 Lincoln Center CITY Stockton 1.. 1❑ PAAACEtslzvAIPNVIU Gettysburg Place Settling Dry Cleaning Defendants (SDCDs*) 1900 Powell St. OWNER .. 'SNAME ,./„ n . old m 9ENeFyV}}} 631 94608 '849 PHONE#510-652-4500 CONTRACTOR ADDRESS LIC# PHONE# owe Road SUBCONTRACTOn Gregg Drilling & Testing ADDnESS Martinez CA 94553 UC# CA LR51h5 PHONE 0910-114-9R00 TYPE OF WELL/PUMP: ❑ NEW WELL ❑ REPLACEMENT WELL ® MONITORING WELL J ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ VAPOR EXTRACTION WELL F J ❑N.11 P,eb M.P. DEPTH PUMP BET_FT. FIRST WATER LEVEL O AVP OF PUMPI ❑ OUT Or SERVICE WELL ❑ GEOPHYSICAL WELL# ❑ SOIL BORING B ❑DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A ❑ INDUSTRIAL 11 OPEN BOTTOM DIA.OF WELL EXCAVATION 19_i Orh DIA.OF CONDUCTOR CASINO N^ne D ❑ DOMESTIC/PRIVATE ®GRAVEL PACK/SIZE TVPEOFCASING/STEEUPVC PVC & steel DIA.OFWELLCASINa 4-inch D ❑ PUBLICMJUNICIPAL ❑DRIVEN DEPTIIOFGROMBEAL 45 feet SPECIFICATION cement-bentonite R ❑ IRRIGATIGNIAG ❑OTHER GROUT SEAL INSTALLEDBBY driller GROUT BRAND NAME E ❑ MONITORING GROUT SEAL PUMPED:QYw [IN. CONCRETE PEDESTAL BY DRILLER:❑Y. [IN. S APPROX.DEPTH An Copt LOCKING CHESTER BOX/STOVE PPE g PROPOSED CONSTRUCNON/DRILUNG METHOD: MUD ROTARY AIR ROTARY AUGER X CABLE OTHER 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS M•PIICATON AND THAT THE WOM WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IB ISSUED,1814ALL POT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR SUR CONTRACTING SIGNATURE CERTIFIES THE FOLLOWING: -1 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT IB ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- THE APPLICANT MUST CALL 24 HOURS IN ADVANCE FOR ALL REOURED IMSPECTIONS AT ROSH Iee+iAfS. COMPLETE DRAWING AT LOWER AREA VIDED. olc J x L--4� \?oT1'B�-. J Till.._. Site Project Manager Die Q PDT PMN ID,.to SoW.)Bede 'fe 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. 4. LOCATION OF HOUSE SEWAGE DISPOSAL BYSTEM OR PROPOSED 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES 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 PROPERTY, RUTLEDGE WAY U mC C waom w AMo HIE o NF 1� • _ =<o o mNa B$8gg F`? p CALNOUN WAY { O �l<3 Ell u e8 $ o F � 0 DOUGLAS ROAD *SDCDs defined in the First Final Consent Decree pA 'T aM�EY and Referenced to Special Master, filed with the Court A January 18,_1996,Q�S�ect,.io�n1IV, Paragraph G �•^ � .� Applledlen AeeNled BY FV,I�� Ll./✓A// D.N �. A,. GrerA Imp.elbn BY Deo. pvnP ImPeellen BY D.te De.mwGen ImPeeBen BY Dd. DeminenH: S x, 'i ncxorwc ip%%-a -t ftr`e .i i- q4-12--7-- L-V ACCOUNTING ONLY: AID# FAC# pit CODES FEE INFO AMOUNT REMITTED CHECKOMASN RECEIVED BY DATE PERMITIGERWCE REQUEST NUMBER, INVOICE o Lo 4.2 123 Pub.Health SEN.-EnvlrO.173(3/96)