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1-4-Athv--, ti6S0'°N W O:0 9106 '61'0;4 awil P;AI;3;� <br />' VVELUPUMP PERMIT � <br />• SAV JOACU1.1 COUNTY Er LRct111Et7TALHFALm DEPAFMAENT 1668 EAST HAZELTON AVENUE-STOCKTON CA95205 - (209) 46834211 <br />VI ON -REFUNDABLE PERMIT CALL (209) 953-7997 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATEISSLED <br />PAYMENT <br />RECEIVED <br />DEC 2 0 201 <br />SAN JOAQUIN COON <br />ENVIRONMENTAL <br />HEALTH DEPARTME <br />JOB ADDRESS 2280 S JackTone RD <br />CROSSsTREer Farmington RD APN_u <br />c,,,Ltockton CA 95215 <br />1O%%-..sR AODREso P . 0 . Box 170 <br />'�u�C.oR Purviance 7rillers, Inc. <br />COaiT.?aeToa Aoo[=ES5 <br />P. Oe 13ox 54 <br />ng-941-49no <br />CITY/STAWJZIP L i n d e n CA 95236 - <br />PROW 209-887-3554 <br />CrrylsTA-M" Linden, CA 452 <br />+SURCONTRACTON PIION' <br />SUBCOVIRACTOR ADDRESS Crn'iSTATVJ7jp <br />j LICENSE _ C-57 _ C•61 ..13-09 Omer Nlllt;s 377923 E,,,AT,, DATE 7131 /17 <br />GEOGR:.PM.CAL IRFCRfak-n . Coordinate's ,". Y Township Range Section_ <br />;rMICED USE = DomesQdprivate wIrrigalionlAgticulturaf L--lndusUlal WalxrQuaily i6ondoring Soil SamplingicharaCcr®6on <br />PublictValerSystem <br />[rGmereAl e]m mne7t M :er S;memN— nwa cnrar.. rs aer <br />TYPE OfYVORK _ NewYVell _ P.eplaamenit-leo :_ WNIAltealion/Madi5calion j OL`tsr <br />- NoedtoTino WaUlS) T0'. vjaUs 903 saing(s) -attcrir.�s - Geolec.1 ical <br />Out-Gasvice>vall _ Oa,-OfSen,ice :VellReneu• l - Cross -Connection Repair <br />New Pulno _=Pump Replacement 0 Pump Repair = Raise Well Casino <br />Drilling Mettiod _ Wud Rotary - AirRolary Auger _ Cable Tool _ Push Point _ Olher <br />Proposed Well Dapth tt Exr--vaJon ii diameter = Open Bottom _ Gravel Pack/Gravid Size in cFameter <br />_ConduclorCasing indiameter f Conductor CazirgDep9i 1Z <br />Well Cas). -,g Ciametar_ cn TbIckne=013auae)ASTIA Sched Steel Plastic C Stainless Steel '1 Olher <br />Grout Seal Deplh;:Nlea1Cement J9S1bb.W_5-JOgaluaferj _Send Cement sarJrrtixf7gal water <br />- 9enlcr.2e,20%soLds) Other <br />Grour Placement Method - Pumped - Free Fall = Other _ Retardant/ Acceleratar(nama) <br />I< F TAL Installed Sy _ Driller 7 Pump Contractor �I Other <br />_ Concrete Pedestal. -Dimensions: bWdth R Length 1 ThJck in _ Christy eoc _ Stoveloiae <br />�Pu : r SubmetstWeL Turbine. .: Other HP Pump Set X70 fl SlarKgng Water Level O R <br />I HEREBY CER'e)=Y THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WIM SAN ` <br />JOAOUIN COUNTY ORDINANCE'S, STATE LAWS, AM RULES AND REGULATIONS- 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS fj! <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS 5TATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />'NORKI=RS COMPcNSATIONA AWS. <br />NO'nCE REQUIRED FOR iMSPEC T IONS - PLEASE CALL (209) 953-7097 <br />zc� Corporate Secretes <br />m <br />r, <br />a <br />m <br />PE I SC <br />Cotler I Info <br />E4ARTftIENT SE LY <br />Amount �� <br />Re rotted <br />Apptcalion Accepted i)y <br />Date b <br />Area Eme:oyee I019iE+%�m <br />��� <br />Gmol Inspection By <br />Oat=_ <br />Z) SPECIALWell Permit <br />Pump rnspcaion Ey <br />M Date 042 <br />WAIVER Received <br />Soil Spring Inspection By <br />Daleonslracied�ylI <br />DDgjpfj%� <br />COrJ1i.iEhTS `S'G�IIRL <br />_ u�/GS /� aELr7 c�E'IZfY� ^ Z <br />'i✓S/�j `yr�K—'� <br />T <br />PE I SC <br />Cotler I Info <br />Received Checks <br />3y i Cash <br />Amount �� <br />Re rotted <br />Perm U <br />Service Request <br />Invoice # <br />Watt I <br />n9l <br />I VVPO <br />EMM 45x9 <br />anena <br />=L:- f" U RVj <br />8'd VLS£L9960Z oul sJeIIIJ4 eoueiAJnd e06:Z6 ZOOZ Inf <br />