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CONTRACTOR <br />JOB ADDRESS/OR APNK 2701 N. Wilson Way <br />OWNER'S NAME U -Haul Company of Fresno <br />Spectrum Exploration, Inc. <br />SUB CONTRACTOR N/A <br />ADDRESS 2365 Wigwam Way uc# 512268 <br />ADDRES6S tockton, CA 95205 uc, <br />Cm( Stockton, CA 95205 PARCEL SIZE/APN/ <br />ADDRESS7 49 N E J .Blackstone Ave.Aye, Fresno 209) 487-1723 PHO <br />PHONE 41( 209) 465-8712 <br />PHONE K <br />GEOPHYSICAL WELL 0 SOIL BORING <br />INTENDED USE <br />INDUSTRIAL <br />DOMESTIC/PRIVATE <br />TYPE OF WELL <br />0 OPEN BOTTOM <br />0 GRAVEL PACK/SIZEN°. 2 <br />AIR ROTARY X AUGER CABLE OTHER <br />0 DRIVEN <br />0 OTHER <br />Monterey <br />Sand <br />fr <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND <br />REGULATIONS OF THE SAN JOAQUIN COUNTY. HOME OWNER OR UCENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH <br />THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIES <br />THE FO " I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br />CALIF PPUCANT MUST CALL24 HOUR N NCE FOR AU, REQUIRED INSPECTIONS AT 1209) 468-3423. COMPLETE DRAWING AT LOWER AREA PROVIDED. <br />Title - • Date <br />4. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PROPOSED <br />EXPANSION OF SEWAGE DISPOSAL SYSTEMS. <br />6. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. <br />ON THE PROPERTY OR ADJOINING PROPERTY. <br />PLOT PLAN (Draw to Scale) Scale <br />NAMES OF STREETS OR ROADS NEAR 0 OR BOUNDING THE PROPERTY. <br />OUTLINE OF THE PROPERTY, GIVING DIMENSIONS AND NORTH DIRECTION. <br />DIMENSIONED OUTLINES AND LOCATION OF ALL EXISTING AND PROPOSED <br />STRUCTURES, INCLUDING COVERED AREAS SUCH AS PATIOS, DRIVEWAYS, AND WALKS. <br />Comments: <br />Date Pump Inspection By <br />Data <br />REPLACEMENT WELL <br />WELL SYSTEM REPAIR <br />H.P. <br />OUT-OF-SERVICE WELL <br />MONITORING WEL K MW-7c-9 OTHER <br />CROSS-CONNECT R AIR El VAPOR EXTRACTION WELL K <br />DEPTH PUMP SET FIRST WATER LEVEL <br />0 DESTRUCTION: <br />PUBUC/MUNICIPAL <br />IRRIGATION/AG <br />k:1 MONITORING <br />APPROX. DEPTH 95' BGS <br />PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY <br />CONSTRUCTION SPECIFICATIONS A <br />DIA. OF WELL EXCAVATION <br />TYPE OF CASING/STEEL/PVC <br />DEPTH OF GROUT SEAL <br />GROUT SEAL INSTALLED BY Pump Si Urry <br />GROUT SEAL PUMPED Yew 0 No <br />LOCKING CHESTER BOX/STOVE PIPE Traffic Box <br />GROUT BRAND NAME Vnlrlay <br />CONCRETE PEDESTAL BY DRILLPR Ezi Yoe 0 No <br />DEPARTMENT USE ONLY <br />Application Accepted By Date Ale- ff-5-Arse <br />Grout Inspection By <br />Destruction Inspection By <br />ACCOUNTING ONLY: AIDF FACe <br />N., <br />PE CODES FEE INFO AMOUNT REMITTED CHEC /CASH RECEIVED Y DATE INVOICE IT/SERVICE REQUES-TNUMB <br />43 ,(37 Aef/fi 444`.oa - t . /72., 7-2-(4. <br />.. _._ <br />0 <br />"11 <br />" to <br /> <br />8" <br />DIA. OF CONDUCTOR CASING N/A <br /> <br />PVC <br />DIA. OF WELL CASING <br /> 4" <br /> <br />58' <br />SPECIFICATION Schedule 40 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />(Complete in Triplicate) <br />apoucxrioN 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 <br />JOAQUIN COUNTY DEVELOPMENT TITLE, CHAPTER 9-111 5.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION. <br />APPLICATION FOR WELLIPUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />P 0 BOX 388, 446 N. SAN JOAQUIN ST., STOCKTON, CA 95201-388 <br />(209) 468-3420 ENVIRONMENTAL HEALTH <br />PFRMITISERVICES <br />L <br />TYPE OF WELL/PUMP: NEW WELL <br />0 INSTALLATION <br />0 New 0 Repair <br />(TYPE OF PUMP) <br />Date