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Pg MONITORING WELL I MW_ 5 <br />D CROGS•CONNECT RERAIR <br />DEVIII row SET FT. <br />CONSTRUCTION SPECIFICATIONS <br />01A. OF WELL EXCAVATION 8-9in <br />GROUT SEAL IN6TAI I ED BY <br />GROUT SEAL PUMPEIY: Li VI. 0 No <br />LOCKING CHESTER noxfsTovE PIPE_ <br /> AIR ROTARY AUGER X <br />0711E11 <br />wknon EXTRACTION WELL I <br />LIURT WATER LEVEL <br />El soil 110r11110 <br />,r71, <br />DIA. OF CONDUCT ort CARING nla <br />GROUT niwto NAME <br />CONCRETE PEDESTAL BY DRILLER: CI Y. DM, <br />CABLE. • OTHER <br />0 <br />A <br />•• C- <br />sr"' <br />0 DESTRUCTION: <br />30ft <br />TYPE OE CAGING/STEFI /I'VC PVC DIA. OF A'El.L CASING 21n <br />DEPTH OF GROUT SEM 2.5ft SPECIFICATION bentonite <br />0 (WT.0E-SERVICE WELL 17:1 REOPIlYSIcAL WELL I <br />INTENDED USE <br />INDUSTRIAL <br />DOMESTIC/PRIVATE <br />PUBLIC/MUNICIPAL <br />ID IRRIGATION/AO <br />'n MONITORING <br />APPROX. DEPTH <br />TYPE OF WEU. <br />El OPEN BOTTOM <br />O GRAVEL PACK/SIZE__ <br />D DRIVEN <br />0 OTHER <br />PROPOSED CONSTRUCTION/DRILLING METHOD: MOO ROTARY <br />LyrE OF WELVPUMP: In NEW WELL D riFri AC( MELD WELL <br />0 INSTALLATION Li von I_ SYSTEM REPAIR <br />13 New 13Reypelr fl.P. <br />(TYPE OF PUMP] <br />AppllowtIon Act:Ivied Fly A.mb-CA <br /> <br />:2(ILY <br />(lr out In.poctIon By_ . _ 06110 3[7—ii C:7 IIy <br />Como:or:IL: 5(4) <br />'.r.op.0l1t..1 By_ <br />Alta I FACT <br /> -A 0/ <br />DATE RECEIVED (11/ <br />fit <br />PETWIT/SETtVICE nrours I NUIVRIEJI INVOICE AMOUNT 'REMITTED <br />ACCOUNTIN3 ONLY: <br />OWNER'S NAME Russell Chapin <br />CONTRACTOR Lush Geosciences <br />SUB CONTRACTOR <br /> <br />VT Drillers j PO Box 51 <br />APPLICATION FOR WELL! PUMP PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICFR <br />ENVIRONMENTAL HEALTH DIVISION <br />P.O, BOX 380, 304 EAST WEBER AVENUE, STWKTON, CA 95201.388 <br />(209) 400-3420 <br />!IP-REFUNDABLE PERMIT EXPIRES 1 YEAH FROM DATE ISSUED <br />(CompWs In TripRents, ArrucATIoN is HERE By MADE To, TDE BAN joApioN col IN I Y ron A PERMIT TO CON8T/IU9T ANDEOR INSTALL TIIF wont< Dr qcnin,Rs. THIS Arrt toATioN 19 MADE IN CTOMPI !NWT' WITif .00,LIN COUNTY DEVE-- <br />..oFmENT TITLE, CHAPTER 9-1 15.3 AN:) THE STANDARDS OF SAN .ETAOUIN COUNTY Runue NrAt.Tif rrrvicEs. rw,inoNmENTAL HE/M.11S op/mots' <br />tx) <br />pA <br />1766 Monte Diablo Avenue CITY Stockton PARCEL SIZE/AMIE_ <br />Aimni,„ 1203 N. .Carlton Ave. ma,9.-464-4349 <br />3560 Business Dr., #120 916-737-9294 ADonrss____SaCtia.. 7 0 IC, RC44 42 1 PHONE I <br />91,70174-E 3,7412815 mmme Rio Vista,94571 m#710678 <br />I IIVIEBY CERTIFY THAT I HAVE PREPARED TI118 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE YVITII SAN JOACIVIN COUNTY ORDINANCES, STATE LAWS, AND RULER AM) REGULATIONS OF IDE 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 PERMITS ISSUED, I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA." CONTRACTOR'S HIRING OR SUB-CONTRACTING SIGNATURE CERTIFIER 10'' THE FOTIOWINGI I CERTIFY THAT IN THE PERFORMANCE OF THE vvorE FOR WHICH T1118 PERMfT IS ISSUED, I BIJAU, EMPLOY PERSONS gunner TO WORKMAN'S COMPENSATION LAWS or cALtronNIA.. THE APPUCANT MUST CALL 34 EITTIMS If 1 ADV." 'ICE FOR m.1. rtEnuntiso !P.11I'T,PR PT !va(') 445 31;.71 r r" TT 1,APA'NG FT t -WM Mr 't Trost.'•,ro. <br />President N'a 2-21-96 <br />'LOT lIJIII (Draw 10 Scale' 8.c..1% <br />1, NAMES OF STREETS OR ROADS NEAREST TO OR SOUNDING THE PROPERTY. <br />°MUNE OF THE PROPERTY, GIVING DIMENSIoNS AND NORD' olnEc TIME <br />DIMENSIONED OUTUNES AND LOCATION OF ALI. EN 'STING AND PROPOSED <br />SEAUCTURES, INCLUDING COVERED AtlEAS SUCH All PATIOS, DRIVEWAYS, AND <br />I OC A ION OF HOUSE SEWAGE DISPOSAL SYSTEM on rnorocw <br />EXPAN:;1011 OF SEWAGE DISPOSAL SYSTEMS. <br />LOC ^,TiO.`1 01 WEL, r, .YITHIN moms or ONE HUNDRED 711.! r I . <br />ON 1 I 11 ',Dram' on ADJOINING PHOPETRY. <br />See Attaohiad: <br /> <br />Y1 AV% yNo <br /> <br />„ 3/1/91, <br />0 ___._ • _- <br />Jon ADDRESS/OR APN, <br />Sltal 41 X