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0yilr^ 9690 '°N W01 L10� 'Ll V2P ;wll paAI ;34 <br /> WELLIPUMP PERMIT <br /> • SAri JoAcam CouriTY ErmorjmawrrALHFtE Tli DEpAFtTnI.- -r 1668 EAST t1PZELTOTt AVENUE-SToCNTON CA25205-{269)$48-3420 <br /> KION-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> to <br /> Jas Aamwas 6250 Escalon Belotta RD crrO,LInden CA 95236 <br /> .70�CRO455-MEET i" l o o d 'RD MLPN IP {,I PfiSiCE4S70" RL13E APPtJCATIPN 0 m <br /> OWNER NA h,E 6�.. a9— 387— fl25 w <br /> OWNER AnDREss ,g fl„� c. RS1 ��1 p rrt �nrFn�v <br /> �ctxtrRacrcR <br /> Purviance Drillers, Inc PHCWr 2n9-$87-3554 <br /> CcnrRAcTW ADDFMS P. a. T3ax 64 Qre#STArEMP Linden, CA q52-3 <br /> Suacorvrucnm PHnatE <br /> S173CONTRACTnR AOORESS CMISTATEMP <br /> ` 377923 7/31 /17 <br /> 1ixlvse C-5'r _G61 � D-t79 _Other NtA+ra1:R F�eP:RAnaN Dare <br /> 3E0GRAPHICAL INFOR,r,MUM: C0ordin21eS X Y Township_ Range Section <br /> rLA10En USE DomesGGPr'cvate M IrrigalionlAgricuiLmi _Industrial 7 WaWOuality MoniLcring° 7�Sol Sz�mplmgFCharaderization <br /> Puhlic Waler System <br /> Ir GiSemrl rrom Ormer. CQVI.15 Nwik—., one untxr <br /> TYPE OPINGRlc NEWLN'e!I _Replacement Well -:VM AreratiorlAAadScalion W Other <br /> D MonAoring VMI(s) :of trreils 1 i Sol BOnng[s) rntba i.0 _Geo'echnical t,Cf boroys <br /> "1 Our-G"ervico Wets --Oul-OF-Ser%ce V�1{Rene al Crass-CbnnecGan Repair <br /> C!New Pum Pum Replacement Purnp Re air -Raise Well Casing <br /> WELL COMSTRUCTSON <br /> Drl[ling Method _Mud Rotary _Air Rotay Auger - Cable Tool -jPush Point _ Diller1Pro7osed Wel[ Depth ft acavalion in diameter Open Bottom 7�C-raael PSCiJGravel Size in diameter <br /> M Conductor Casing r diameter I Ccnduclor Casing Depth R <br /> I Well Casing Ciampttu_in ThiccnessfGaugeJASTht Schell i,Sleel 7PIasfrr = Stainless Steel 2 Other <br /> l GrnutSeal Depth ft Q Neat Cement(941b bays-10galxafei) Sand Ce]cenl saat n3Ly,7 gal crater <br /> 6entarite(20%solids) -,Other <br /> GroatPlacementMethod �Pwr:ped -Free Fall -Cther L.RetardentlAcceleraior;name) <br /> PECSSTAL Installed By -Diftr s Pump CaNractor _ Other <br /> i Concrete P®dostal._Dimonerons-lArtetn !t Length ItThicl: in __Christy R= ;-StoveRpe <br /> Suhmerst lefTu bne .yDlher HPZ-� Pump Set O. ft St nding WerterLevel rt PAY <br /> APPLICATIONI HER:"Y CERTIFY THAT I HAVE PRF-PARED THIS AND THAT T14E WORK WILL eE DONE IN COMPLIANCEp <br /> JOAQUIN COUNTY DETAAWS RULES <br /> AREGLATINRSO TIFYTH,4YREQUIRED <br /> EQEDLI €AND ACTIEhTTHTRE FfRNIA ¢NTRBOARD AND tNW _ ��C��+✓ <br /> tM1IORIS NSAT1flN �. D <br /> MWou 24 M ANGf=NDTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 { �p ?O}� <br /> 51ONED t TI7lE Corporate Secre 44V Z f )AQV ,cOU <br /> ! <br /> I <br /> FArr <br /> I i <br /> X i. <br /> i I <br /> i <br /> I 1 <br /> 10`11 <br /> i <br /> I _ <br /> i I 1 <br /> k <br /> ' I <br /> EP R`T•V ENT 41SE JONLY <br /> ApgAcation Accepted By Date L•rza Ernp)oyee <br /> Grout inspection By Dale_ 47, pe�aL Well Permit <br /> Pump Tnspect'an By Date . WAIVER Received <br /> Sol Baring inspectianBy _` Dale ConslructedWell Depth h <br /> COMMENTS. <br /> ?ESC )aceived rheckk! Amount Date ParrniF/ ^Invoice# Well tDll <br /> Godes Info B szt Remitted I Service Re9ue-st# _ <br /> / - a <br /> EHDe3A6 lV <br /> VI .�.L 0.Lrel1!JPPEN r]tT <br /> 4302 <br /> 8'd tlL��L886N oul sAellp(] aouel,vnd d£0:90 ZO L l 5nV <br />