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APPLICATION FOR WELL/PUMP PERMIT}
<br /> SAN JOAOUIN COUNTY PUBLIC HEALTH
<br /> ENVIRONMENTAL HEALTH DIONRVICES
<br /> 304 EAST WEBER AVENUE, STOCKTON, CA 952 '
<br /> (209) 468,424
<br /> NDN-REFUNDABLE PERMIT EXPIRES i YEAR FROM DATE ISSUED
<br /> APPLICATION CO IB HERE BY MAbE TO THE SAN JOAOUIN COUNTY FOR A
<br /> JDApUfN COUNTY DEVELOPMENT TITLE.CH ICoMP1/T/M TTIpI1eIRN
<br /> APTER 8-1115.3 � �i0 C0 aTRLICT AND/OR INSTALL THE%M
<br /> JOB ADORE 881pR AppiN ( / 1 z AT'fD THE STANDARDS OF SAN JOA rt1C DESCRIBED.TILTS A
<br /> ✓ a.•. l .Y,rl IF S. OUIN COUNTY PUBLIC NEALTN BE PPLICATFON IS MADE IN COMPLIANCE N4TRI SAN
<br /> j -4 ,�.�- RVRCEB,ENVry1pNMENTAL HEALTH bMSION,
<br /> DYIRIER'8 NAME ` ,.:+c t-" r C, ✓, CrTY ! �j.,x� I
<br /> CONTRACTOR {d t�!{ �_L,�v , ADDRESS 1-11 " .�. I;1 4 r u•1 PARCEL SIZEIAPNI .(1�
<br /> sue CONTRACTOR 1(It k,"J } ADDESsR
<br /> ki L�,.1J 4 ) t14'P.r 65 UCI
<br /> riPE Ot�� O NEw ADDRESS 'l7 , ., St 4 L PHONE•
<br /> WELL ❑REPLACEMENT WELL
<br /> V4 31NLIC/ �; �' g
<br /> PHONE f lri fi Is�
<br /> ❑INSTALLATION ❑ WELL SYSTEM (3 MONITORING WELL/
<br /> �, ❑Now REPAIR 11CROSSCONNECT REPAIR ❑OTHER +yam
<br /> YFIE OF PUMP) DEPTH
<br /> fTVAPOR EXTRACTION WELL /
<br /> DEPTH PUMP SET
<br /> FT,
<br /> nDESDVT-OF-SERVICE WELL FIRST WATER LEyEL
<br /> TRUCTION: ❑ GEOPHYSICAL WELL! '��� P
<br /> r i+ ,�r V� „ 1P {�. ��_ ❑ BOIL BORING
<br /> TTPE� pL S
<br /> D INDUSTRIAL 0 M BOTTOM CONBTRUC710T1 iPECIFICA IONS
<br /> ❑ *M(9tRCIIMIRVATE DIA.OF WELL EXCAVATION
<br /> ❑GRAVEL f ACKIBI;E
<br /> TYPE Of CDIA,OF CONDUCTOR CASING
<br /> ❑ PUBLI MUNICIPAL [:j DRIVEN ~ ABINGISTEEIRVC ?�Ci 1.. p
<br /> ❑ lRRp0A710N1AG
<br /> DEPTH OF GROUT BEAL a+C) �A'OF WELL CASING L
<br /> SPECIFICATION L D
<br /> „ - OTHER GROUT SEAL INSTALLED ALLED BY {,vdr R
<br /> OROtIT BRAND NAME r r .�*1 w' �i� N'-y.�,�I �.
<br /> OROVT SEALPUMPEO:mayes ON* E
<br /> APPROIL-DEPTH (21 CONCRETE PEDESTAL BY DNLLER:❑Y. ION.
<br /> LOCKING CHESTER SOXls7pVE PIPE S
<br /> PROPOSED CONSTRUCTIONMWLLING METHOD: MUDROTARY S
<br /> ' AIR NOTARY AUGER CABLE
<br /> OTHER
<br /> 1 HE9EBY CERTIFY THAT 1 f{AVE PREPARED THIS APRICATION AND THAT THEM WILL BE DONE IN ACCORDANCE WITTN SAN JOAOVIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND
<br /> REGULATIONS OF THE SAN JDApUfN COUNTY• HOME OWNER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING:'I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH
<br /> THIS PERMIT IS ISSUED.R SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S ERRING OR SUBCONTRACTING SIGNATURE CERTIFIES
<br /> THE FOLLOWING: '1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISBVED,I SHALL EMPLOY i'ERHONS SUBJECT TO WORIGMA AC LNG SIGNATU E LAWS OF
<br /> CAUPORNIA.' THE APPLICANT MUST CALL 24 HOUR/IN ADVANCEpp--FCR ALL REOUIRLIO INBPSCTONS AT f20/I 4pJ433. COMPLETE DRAWING AT LOWER AREA N'S COND.
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<br /> PLOT PLAN 1Dttwv to So.faf Boal.
<br /> 1, NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY, 4, LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR Pr1OPOSfb
<br /> 2. OUTLINE OF THE PROPERTY,GIVING DIMENSIONS AND NORTH DIRECTION. EXPANSION OF SEWAGE DISPOSAL EMS.
<br /> SYST
<br /> 3. DIMENSIONED OUTLINES AND LOCATION OF IN
<br /> ALL EXISTING AND PROPO/EO B. LOCATION OF WELLS WITHIN M S T ONE Rt1JNOREO FIFTY FT.
<br /> BTRUCTVRfES,INCLUDING COVERED AREAS SUCH AS,ATOS,DRIVEWAYS,AND WALKS, ON THE PROPERTY OR ADJOINING PROPERTY, f
<br /> N W E S T S 0 N o R A S T R E E T
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<br /> - � ..p GENERALIZED SITE PLAN
<br /> FIRE ENGINE COMPANY N0,2
<br /> 110 WEST SONORA STREET
<br /> STOCKTON, CALIFORNIA
<br /> . - PREPARFO FOIL
<br /> +r.w-: 1 FIRE ENGINE COMPANY No.2
<br /> SOCKTON, CALIFORNIA
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<br /> ' O.eut lmpaelbn Br '� ^'" Dal __.P n p ImpmtIen By Date
<br /> p—14an Inaveatlen BY Qate
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<br /> ACCOUNTING ONLY: AIDS FACF
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<br /> PE CODES FEE INFO AMOUNT REMITTED CHECKEICABH RFCBVEEI iv DATE PERMITISERVICE REQUEST NUMBER INVOICE
<br /> 7 (10.00
<br /> 77 '
<br /> Pub Health Sere.-Enviro-173(1/97)
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