FIELD DOCUMENTS_1997 - Laserfiche WebLink

Home Browse Search

,PPLICATION FOR WELLIPUMP PERM( SA AOUIN COUNTY PUBLIC HEALTH SE ES ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON, CA 96202 (209) 468-3420 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete In Trlplknto) APPLICATION 18 HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANDMn INSTALL THE WORK DESCRIBED.THIS APPLICATION IB MADE IN COMPLIANCE WRIT BAN JOAQUIN COUNTY DEVELOPMENT TITLE,CHAPTER 9-1115.3 AND THE STANDARDS OF BAN JOAUUIN COUNTY PUBLIC HEALTH SERVICES,ENVIRONMENTAL HEALTH DIVISION. Wy ` / JOB AODRESWR AM# 374 Lincoln Center CITY Stockton PARCEL SIZE/APNIV, LCN✓l TITLING DRY CLEANING DEFENDANTS SDCDs * CA 94608 OWNER'S NAME C/o Donald T Bradshaw. Lev ine-Fricke-RecomvDRF681goo Powell St. 17th Flr F r'n@IGNE#l51n16S�-a5nn CONTRACTOR ADDRESS Uce PHONE/ 11350 Monier Park Place sun CONTRACTOR Transglobal Environmental Geochemis try Aoonsse Rancho Cordova. CA 95749ucI PHONE 8Gn1n TYPE OF WELLIPUMP: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL I ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL ❑Naw❑Rroeh H.P. DEPTH PUMP SET_FT. FIRST WATER LEVEL O DYPE OF MMPI ❑ OUR-0E-SERVICE WELL ❑ GEOPHYSICAL WELL! ® BOIL BONNGV O B ❑DESTRUCTION: INTENDED USE A TYPE OF WELL CONSTRUCTION BPECIFICATIONe ❑ INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION 1-inch CIA.OF CONDUCTOR CASINO N/A D ❑ OOMESTICIRIVATE ❑GRAVEL PACKISIZE TYPE OF CASINGISTEELIPVC N/A DIA.OF WELL CASINO N/A D ❑ PUBUCIMUNICIPAL DRIVEN DEPTH OF GROUT SEAL N/A SPECIFICATION cement-hentnnitO R ❑ IRHIGATIONIAG ❑OTHER GROUT SEAL INSTALLED BY N/A GROW BRAND NAME N/A E ❑ MONITORING GROUT SEAL PUMPED: ®Yr 11 N- CONCRETEPEDESTALBYDRILLER:❑Vw ❑N.N/A S APPROX.DEPTH multiple borings 5 to 45 ft bgs LOCKING CHESTER BOX/STOVE RPEs PROPOSED CONSTRUCTIONIDRIWNG METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER Hydraulic Push I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH BAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULER AND REGULATIONS 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 IS ISSUED,I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.- CONTRACTOR'S HIRING OR BUB-COWMC71NO SIGNATURE CERTIFIES THE FOLLOWING: •1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 19 ISSUED,1 SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' THE A CANT MUR LL N HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONG AT VHNN 4"S 2e. COMPLETE DRAWING AT LOWER AREA PROIDE . mprotl x .( TI. Site Proiect Manager D•I. � y� PLOT PLAN ID'.n 1.SOYaI Baals •to 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. /. LOCATION OF HSEWAGE DISPOSAL SYSTEM OR PLO1'OSFD 2. OUTLINE OF THE PROPERTY,GANG DIMENSIONS AND NORTH DIRECTION. E%PANSION OF SEWAGE DISPOSAL O 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED S. LOCATION OF WELLS WITHIN RADIUSSOF F ONE HUNDRED NFTY NFT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. cV 9 r� _D #2 .` ' CPR 212 CPT 202 CPT 207 CPT 215 . \ Mw-5 W i X-CPR 217 . `. CPT-203 #6L . ... 1 CPT 210 ',. CPT',214 CPT 715 ' i CPT-216 ' CPT--204 I i DEPARTMENT USE ONLY AppVwl.n Aa. Iw B D.R Ara. -� Or.A ImpxtleR BY -y Det• Pm InpmGpn By Dots D.I. D..rrwGen IrvPmtbn Br C..m.,H: 57G �ZYIC-��LC(rI VYWt111" 2.�huf' - 3D�f•L1l NaS - D'L q•2.93 xpt✓'es �I 1.99' ACCOUNTING ONLY: AID# FACP PE CODES FEE INFO AMOUNT REMITTED CHECKNMABH RECEIVED BY DATE PERMIT/SERVICE REQUEST NUMBER INVOICE 2 d g3 q. .q D I 55 Pub.Health Sew.-Erviro.173(1/97)