Laserfiche WebLink
SAN JOAQUIN COUNTY EHYIRONmEHTAL HEALTH DEPT V00- ash aselton Avenue-STOCKTON CA 95205-6232-(209)468.3420 <br /> NON-REFUNDABLE PERMIT _ CALL 209953.7 97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS N et' TonC5 T'ract/A. /V Crry/Zip S-ti) iDyAf ZOO � <br /> Q 11 ` Iy"e� J � {� r� 0 <br /> CROSS STREET. 6 <br /> . 6 W Yt 1 S M&n d ek APN._I2/ct " O V�" �^ PARCEL SIZE —_ LAND USE APPUCATION# J <br /> QQ {� I \ y p Q <br /> OWNER NAIVE E V M U+J1} _ ,/PHONE_4 y�J Z�T I.O J P <br /> OWNER ADDRESS 3 k 1 Sty til "r CrrY/STATEOP_ V A k4ar,4 I CA I^LM f <br /> CONTRACTOR _TY ULA.W f,Lk �( FOO "-11- L C K' A k L t 0-il {J1 PHONE } <br /> CONTRACTORADOR..ESS 90l ll ST- �rd�'' k,ly�O� CRYISTATEM OQ II_tQY�Q� <br /> SUBCONTRACTOR 6 r r r + <br /> Q S C S ylY'l 1 C,. PHONE [a2s)`A-[3�I 3- <br /> SUacoNTRAC7OR ADDRESS OCh C((rr�TYIST`A`TE//ZP Maf tE,{{ y-i {_ <br /> r A4553 <br /> LICENSE C-57 7 GE1 !' D-09 Other NUMBER `I ✓l lP EXPIRATION DATE t 3I <br /> GEOGRAPHICAL INFOAl lAT10N: Coordinates X 12-10311'52.30 Y 3 5(rr 11.510 Township_Lj�, Range ISI Section <br /> INTENDED USE Oomestic/Privale, D 1mgatioriAgricultural Industrial D Water Quality Monitortng Nsail Samplirg/Characterization <br /> _Public Water System <br /> I diltarent kern Own�sr. WOW y.[­ am. eme d on.l <br /> TYPE OF WORK C New Well -i Replacement Well i"Well AltaratienlModification [.1 Other <br /> M of boring. a <br /> 7 Monitoring Walls) #of wells J$0Borings) XGeatechnlcal of twang. <br /> Out Well :7 Out-Cf-Service Well Renewal Cross-Connection Repair <br /> New Pump 7 Pump Replacement 7 Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ' Mud Rotary 3 Air Rotary Auger -Cable Tool Push Pont 7 Other <br /> Proposed Well Depth 45 ft Excavation _in diameter _;Open Bottom 7 GravelPacIdGravel Size _ in diameter <br /> .7 Conductor Casing in diameter ! Conductor Casing Depth ft <br /> Well Casing Olameter in Thickness/GaugelASTM Sched <br /> Steel �!Plastic Stainless Steep C Other <br /> Grout Seal Depth ft K Neat Cement e94 to bag/5- 0 ga!water)` 'S Sand Cement sack mixl7 gal water <br /> � Bentonite(20`YG solids) X Other ,A G�Ctz [,N1��L L,Jt})I'1 CAy Ux''* Ayyyk µeoYN <br /> Grout Placement Method X Pumped '!_' Free Fall -i Other RatardarIt/Accelerator(name) C.e 1 Coon <br /> FP FoES7A Installed By Dnlier ._ Pump Contractor Other <br /> 7 Concrete Pedestal Dimensions:Width ft Length it Thick in 2 Christy Box —1 Stove Pip;-- <br /> Lu_­ <br /> ipePUMP 7 Submersible:Turbine :Other HP Pump Sol ft Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> IOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. t L L I an q & LAl ell Corn * — CM^I I ad Are S S <br /> MINIMUM 24 HOUR A6VANCE NOTICE REQUIR�ELD. FOR INSPECTIONS <br /> SIGNED TITLEI CC.^I ^, GI'1 QI— DATE fp'I2 <br /> _ EA SL adY <br /> f "6W1C/-A4 <br /> 41r/41r, <br /> LoGa 30y V' _ P <br /> i7 0 o z 1* s�, to <br /> SA";W rscevn C <br /> O ROAD <br /> + MDWJWARO 7JN.4r. rn <br /> m <br /> f� *001 r vrcraey. CANAL 7D {{{w����5 �AI YM E NT <br /> pPGS y RlEIVED <br /> i <br /> n �► w w J - 1 2012 <br /> $rsrE xieNrer Raurr Ha {+ T- ¢ �kN_i(-. QUIN COUNTY <br /> ENVIRONMENTAL <br /> EALTH DEPARTMENT <br /> D AI� ENT USE NLY <br /> Application Accepted By. - ale , Area Employee IDS <br /> Grout InspeeUon By Data SPECIAL Well Permit <br /> Pump Inspection Y. z2r 'bate WAIVER Received <br /> Soil Boring Inspetion B - 'Date Constructed Well Depth ftENTS X �.l G" /C.ITr_ � C [_� cG_J 7,=F / /_t�1r►'I,S - � L <br /> PE SC Received Check Amotutt Permitl <br /> Codes Into B Cash Remitted Date Service Re Uest# Involve# Well IDS <br /> EHD 430 wELL/PUMPPERMiT <br /> amams <br /> .::;mk , 928-ZZ/- 5 3 3 <afV_ <br />