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1APPLICATION FOR WELUPUMP PER SAWOAOUIN COUNTY PUBLIC HEALTH S*ICES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 95202 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED APPLICATION IS HERE RY MAOE TO THE SAN JOAQUIN COUNTYFOR A PERMIT TO CONSTRUCT IAND/OnINSTALL THE WOO(DESCRIBED,THIS APPLICATION IS MADE IN COMPLIANCE WHIZ SAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1116.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. JOB AODRESWOR ATRIA 374 Lincoln center recm, Stockton TT $ett IRVE ry eaninag en en S S 19 a PAROELSIZE/AmLeeshnrg Pi n owNEfi uAME_c/n on 1d T R ai h w Levin cke Rec0nAODRE68 Emeryvil le CA 94608-1827 RIONE/ SIO-6S2-4500 CONTRACTOR ADDRESS UC/ sua coNrrwcroR Gregg In-Situ, Inc. 950 Howe R PHONE ADDRESS Martinez CA 94553 UCICA 656407 PIDNEt515-313-5800 TYPE OF WELL/PUMP• ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL/ ❑ INSTALLATION 11 WELL SYSTEM REPAIR ❑ CROSSCONNECT REPAIR ❑ OTHER ❑Ne\v❑nePJ M.P. P ❑ VAPOR EXTRACTION WELL I J HYPE OF PUMP) DEPTH PUMP SET-_--yr. FIRST WATER LEVEL D ❑ 11 DESTRUCTION: OUT-OF SERVICE WELL 11GEOPHYSICAL WELL A ki SOIL BORING B INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS 11 INDUSTRIAL 11 OPEN BOTTOM A DIA.OF CAO,NaELL EXCAVATIONuv7-i OrhPC OTA.OF CONDUCTOR CASING N/A ❑ DOME9TICR'111VATE 1:1 GRAVEL PACK/SIZE TYPE OF CASINO/BTEEVPVC Nva D ❑ PURLICIMUNICIPAL ❑DRIVEN DIA.OF WELL CASINO NIA D OEPTf1 OF GTIOVT SEAL_ Total ➢ th 8PECIFICATION C m n -Rentonit ❑ MONITORING 11 OTHER GROUT SEAL INSTALLEDBYContractor GROUT BRAND NAME_ N/A R ❑ MONITORING GROUT BEAL PIMPEO: Dy. ❑Ne E CONCRETE PEDESTAL BY DRILLER:❑Y. ❑Ne S APPROX.DEPTH _ Rp feet LOCKING CHESTER BOX/eTOVE PPE N/A PROPOSED CONIIAVCTIOH/DFEIEING METHOD: MUD ROTARY S AIR BOTANY AUGER CABLE OTHER Hydraulic Push 111EPESv CERTIFY THAT 1 HAVE PREPARED THIS APPJCATION AND THAT THE WOIK:1:1:ILL BE DONE IN ACCORDANCE WITH SAN JOAGVIN COUNTY LLWIOROUWB, REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER On LICENSED AGENT'S SIGNATURE CERTIFIES THE FOONG: STRF RULER AMC 'I CERTIFY THAT IN INANCEB,THE PERFORMANCE OF THE WORK AND AND FOR WHICH TI419 PERMIT IS ISSUED,I SHALL NOT EMPLOY PERRONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR BUB-CONTRACTING SIGNATURE CERTIFIES TIIE FOLLOWING: .1 CERTIFY THAT IN THE PERFORMANCE OF THE WOR(FOR WHICH THIS PERMIT 18 ISSUED,1 SHALL EMPLOY PERSONS BI/EJECT TO WOgKMANY COMPENSATION LAWS OF CALIFORNIA,*\ THE APPLICANT MUST CALL QI HOURS IN ADVANCE FOR ALL REQUA ED INST'ECNONI AT 1]081489) 20, COMPLETE DRAWING AT LOWER AREA PROVIDED, ele^^^ Tnle Site Project Manager 1. NAMFS OF STREETS OR MAUR NEAREST TO OR NOUN MOT ONG TMAN P(0,.UY�NeI 88.18 -to 2. OUTLINE OF THE PIMPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. 4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OB PROROSED 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING ANO PIOPOBED EXPANSION OF SEWAGE DISPOSAL SYSTEMS. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTYON FT. \ \\ \ E ^ I ' \y�. .a\; \• \ \ \. IAC.>ai PO FITY DRADJOINING \PER\ry. • `\....- _ Mfr \ \\ \ yfBi\ 1 .-1 D 11 \ Y.{^\ \ \ _, �._i \ A.,.. NOJt y NW-IOOA\ C CPT-x19 ` W WW- L I \ y ! OR,�t_ - _i_._, �---_� ,-;`.1 �'�'�°C�\ \\ \\ \ ,a'vi�T-1 . '�•AR"""T°ter.'/' ':`I I \ 1 I � a\ + •• y ,•r/w� L• v rl •\ ...r-'I II --'i n f-- - I l._1-aK '..��1 .. 1 .\ -�'.- n.�-' �� q n �' \ �✓`::�'®E ...9 1 : 1--- �-°I"-� \ � ..iY a>•I_nq.--` - \ Pte«. / I •I AOT-.• \. \ v,Re..%' , C6..(•n: \ \ A� / a."r + _.� .. �;.. \ ~J ®I ___�, { � \ \ ,.�J'SptV[`�`..�, \ \?.\\\\ y..-1ax.L•l� vim' �./ "` ?b.�. \ \ { , -�'.� 1 Y/ �-..�T"-; � 1 1 \ ` \ � ?dim T '. \ � �•\ FSleds deflned Ln the First Final Consent decre ue4 dM ive,gol�vnt and Referenced to $pecialMaster Filed with the Curt on January 18, 1996; Section , paragraph G. AVP)Icnbn Ae.e LR BY D.R /O-L•'{• '� Ma Draw Impmll n By O.la Pune ImneeOen By D.I. be.Invllen Imneetlon By Gemmenl.: c PubILL Wor �5 fxct ccl LrncA td �c✓iylL� q� ��9 u/ Sac (z c51 ACCOUNTING ONLY: AIDS FACF PE CODES FEE INFO AMOUNT REMITTED CNECKMASH RECEIVED BY DATE PERMIT/SEIIMCE gEOUEeT NUMBEII INVOICE 3a2D L4D D Pub.Health Sew.-Enviro.173(1/97)