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i <br />WELLIPUMP PERMIT <br />SAN JoAOUIN Cowin ENMRowmxTAL l-ALTN DBARTa"T ISM EAST HA2iTON A*m.,E • 810=1 CA 85206 • (209) 4663420 <br />NON -REFUNDABLE PE , -UT CALL 9337 FOR NfSPEGTIOli3 1 YEAR FROM DATE ISSUED <br />Joe AccutEss G o !mac c, 957,E <br />CROs STREET APN Q 2 7/ .ARM SM LAM At�ueATgN tY <br />OWNER NAwE U V Gc a d. N <br />Dla,- i n1aNE �1 a - k - <br />OWNER ADDRESS �/ C'/ 0 0 To <br />CONTRACTOR n-r(J,„(�a,). <br />CONTRACTOR ADORF,S¢ V t <br />SUBCONTRACTOR N /y <br />SUBCONTRACTORAmms /" CRYlST umip( % <br />LICENSE C-57 C-61 D-09 Nt91S6T Z ]_LEO �{' � CWMWM DATE Gi r <br />GEOMANOCALI »oN: Ceerdalat$*X Y Te-Wmp_Raai0 Section <br />INTENDED USE VDarnesbaPft2te Inlgation/AVIcUtral Irdustrof Water oulli ty MOttNr m Sol <br />Public Water SvstEm <br />TYPE OF WORN New well --- Reptacernrd wetl W/9 Alterabon&iloddlaZon - O&W - -- <br />monitonng wed(s) S Or wetly Sod Borfrq($) 8d I . Ge0B6ahrcal ed" g <br />ustn �r�nce w� �nrtwroerv� w rcana�w� wrmon r=pw <br />New Pump Punt Rose Well Catft <br />0'" .y ai A�, - D -'.W Ql}pr <br />Proposed W60 Depth_ft F m fttbn in diameter Open 8omaa Gravel PeddOwmel Sae in diameter <br />Conductor Casing in darnew / Conductor Casing Depth 4 <br />Well Casing Diameter _ in Thldel6s&0ujge/ASTM Sched Steel PIsOc Sbirdm Steel 06w <br />Grout Seal Depth It Neat Cement ('94 tb bay�S-109W w owl Smd sadr m&7 gW wateri <br />Bentonite (2D% sokh) Oalx <br />Grout PW*n nt Mdhed Pumped Fro" Fal Other Reta dent / Aoahalm(tla 6)— <br />PEoesTAL Insh ed By Dryer . Pump Contractor Ogler <br />Concrete Pedestal Dlmenslars: Width _ It Lerglh R Thick in am : 3twm Pipe <br />Porto SLb"arside Turbine O&w HP Pump R ftnay Water L84-= h <br />HEREBY CERTIFY THAT I HAVE PREPARED TMS APPLICATION AND THAT THE WORK WILL BE DOZE N ACCORDANCE WR14 SAN <br />JOACAJIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO 0817" IM MY RECIIAM LICENSE is <br />CURRENT AND ACTIVE WRH THE CALIFORNIA CONTRACTORS STATE UCENSE BOARD AND THAT 1 AM N COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAW!. <br />MINIUM 24 NOLIRfDV NO E REQUIRETIDD FOR SPECTTONS PLEASECALL (209) <br />S cN� 9 T <br />Applwalion Accepted By <br />Grout Inspection By <br />Pump In$pemon By <br />Soil Bonng Insoecum By <br />COMMENT$ <br />EP RTMENT EO LY f <br />` Date V Area Empl"yee I171fG <br />Dare SIAL Well Permit <br />Data = WANOM ROC61hre d <br />Date Ca s&udwd Wd Depth It <br />E^c',x WELL AI Ai PabwT <br />.ao,z <br />