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N APPLICATION FnR WELLIPUMP PERMIT I-FSTRUCTION) JOAQUIN COUNTY PUBLIC HEALTH SERVIL ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, STOCKTON. CA 95201388 (209) 488-3420 MON-REFUNDABLE PERMIT _ 1 APPLICATION IS HERE BY MADE TO THE SAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WORK DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCE WITH SAN JOAOUIN COUNTY DEVELOPMENT TTTLE.CHAPTER 9-1116.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLI4j)3C HEALTH SERVICES.E VW40NMENTAL HEALTH 1IVI8ON. Joe ADDRESNHOR APNs Jj&lg Mt. Diablo Ave. CITY Tracy PARCEL-mAF'NP^.04 acre owNER-SNAME San n Joacruin County Awms>z304 E. Weber, Stockton P.„E, 468-3420 CONTWICTOR EMCON ADDRESS 4233 W. Sierra Madr ;� resno X275-4968 SUBCONTRACTOR_ V & W Drilling, Inc. P.O. Box 51 , Rio Vista - 7 �"- ADDRESS , 04 PHONE, -7g1 5 TYPE OF WELIJPUMP ❑ NEW WELL ❑ IEPI.ACEMENT WELL ® MowroHNO WELL!W—�yMW—2 ❑ OTHER ❑ INSTALLATION ❑ WELL SYSTEM REPA R ❑ CROSS-cowECr REPAM MW—3 ❑ VANOR EXTRACTION WELL. J (TYPE OF RIMP} ❑N.w❑R,.k H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL O ❑ OUT-OF•SERVICE WELL ❑ GEOPHYSICAL WELL I ❑ SOIL WINO X3DEerRUCTmN: _ThrPP r)Iln(jwat-Pr monitoring wells (MW-1 , MW-2, MW-3) INTENDED-USE TYPE OF WELL CONSTRUCTION SPECIFICATIONS A ❑ INDUSTRIAL ❑OPEN BOTTOM aA.OF WELL EXCAVATIQN 12, 8, 8 inches DIA,OF CONDUCTOR CASINO NA D ❑ DOMESTICR'iWATE ®GRAvEL P^mmimf�onestar#3 TYPE OF CASINa/vTFF,L/PYC Sch. 40 PVC DNA•OFWEU CASINO 4 inch D ❑ PUBLIWI-UUNICWAL ❑DRIVEN Sana DEPTH OF GROUT SEAL 1-1 1 fPPt SPECIFICATION . R ❑ WRIGATIONIA0 ❑OTHER GROUT SEAL INSTALLED EDgy Exploration GROUT BRAND NAME __ E ® MONITORING GROUT SEAL PUMPED:�Y.. ❑Nlyeoservices cONcRETE PEDESTAL BY DiUt1ER❑Y. APP"X.DEW" 30-35 feet IDN. S LOCKING CNESTEA BOX/STOVE PIPE S PROPOSED CONSTRUCTIONIMI UN0 METHOD: MUD ROTARY AIR ROTARY AUGEm HollowcAgu OTHER Stem 1 HEREBY CERTIFY THAT N HAVE PREPA M THIS APPLICATION AND THAT THE WOW WILL BE DONE IN ACCORDANCE VMH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULE AND REGUlJ1TIOM8 OF TILE SAN JOAQUIN COUNTY. HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING--1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 38 ISSUED,1 SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COINP%NSATiON LAWS OF CALIFORNIA.- COIITAACTOR-S HIRING OR SUB{OHTRACTMJG MNATURE CERTIFIES THE FOLLOWING: '1 CERTIFY THAT IN THE PERFORMANCE OF THE WOW FOR WHICH THIS PEFOOT 18 ISSUED-I SHALL EMPLOY P€RSON8 SUBJECT To WORAMANY COMPS: ATION LAWS OF CALIFORNIA.' THE APPLICANT MUST CALL S4 HOURS IN ADVANCE FOR ALL REMOW PitPSCTIONS AT L2M 446J472. COMPLETE DRAWING AT LOWER AREA FROVIDED. SbmedX Ott- ��L�-d�J7-t .�_X Thw GeolcaistD.t. 12/2/97 ►LOT PLAN Mvh to fioel.l Sone 'to I. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PMPERTY. 4. LOCATION OF HOUSE SEWAGE DISpOgAL SYSTEM OR PgOPOREU 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION, EXPANSION Of SEWAGE DISPOSAL SYSTEMS. 3. DIMENSIONED OUTLINES AND LOCATION OF ALL EXtST)NG AND PROPOSED S. LOCATION OF WELLS VM'"N RAORUS OF ONE HUNDRED FIFTY FT. STRUCTURES,INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS.AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. w. ...• ...p... ..p... .. .. ... .. .. ..i. .......... : ... . .. . ..: MAP ON BACK . . . .p::... .:.. •...... .... ............ .............. f .. ......I...... . ...... ....... ..................! . -.-............ ...........- ............. ....... ................ ........ DEPART~USE ONLY Date -] A4,PIw.tbn AeoeoteQ By 1Z O ! / Date Grout ImPxtion By Dot. Punw tr+.oectlon By Llste bawrwlt ftn hwPactkr,By D.te nZ , : 3� �/ � �s- AccoVNTiNa ONLT: ALD/ FACS PE CODE; FEE INFO AMOUNT R13ATTTED CHIEC"M'ASH RECEIVED IY DATE P9gN1TASERVICE REQUEST NUMSER INVOICE '-CIO Z. Wb II