Laserfiche WebLink
o,JNA <br />WELUPUMP PERMIT <br />SAN JoAoum CouNTY Emvow mmTAL NEALTN DOARTMOM IM EAtrr HA2a.TON A"WM-91aORON CA85206 -126=) 46&4M <br />NON-REFUNDABLE PERMIT GALL 209 953-T697 FOR1 YEat FROM DATE im= <br />Joe <br />0 C (2 Q <br />��-��F.,I'TI APN PAq�S13 {�,�Np 710N# OwNErt NAGE `� K c, (p(� — 2- <br />`, <br />..VIA � , ` �"" <br />GONTRAGTDa l Y r l L Ptramd 1;;ZEtiV� d, () <br />CowmAcTTm ADtN1E7e C. <br />m <br />s <br />SuecorrrnwcroR AComm* I I Alm I V- 1 <br />UCENSE G57 C-61 D-09 OM NUIEM J�israrr,DAW <br />GEOGRAP1eCAL INcgk A'ttd+: Ceonliru As X Y Town"_ Range Section_��� <br />INTENDED USE V OcmasDaPrivate Infgat VAgACDbXaI IndUSbtf Water Quality MDnWril; Sol <br />Pudic W. bystem <br />n Buten l tram owur. <br />TYPE Or Wcatt New Well Repiaeemsnt Well Well Aft8r2fioNUodification Otter <br />mondaing Wee(S) Dor web Sod Borings) sdnann0 . cogum sucal <br />Out -Of Seniee WAY' OutOfSeryme Well Renewal crams-Comeown Rmpok <br />Driling Madiad Mud Rotary Air Rotary Auger Cable Tod Ptah Park O6,ar <br />Proposed Wall Depth ft 6x2vaton in diameter Open Bottom Gravel PeddGmvel Sae in dWrAW <br />conductor ea mm in aameter / conductor Gesuv Depth It r\ <br />Well Casing Dian _ m ThKWwsW1Gau))e/ASTM S iced Steel Ptotic SlaWM Steel Other <br />Grout Seal Depth ft nkat Cement (94 !b bamS10 9W wabr) Sid ss0 med7 gal water <br />Berwi to (20% solids) Other <br />Grout Placement Method Pumped Free Fd Other Retardant / ADoalera w (nerua) <br />Pe�rw, Irtstmew By Diller . Pump Cenbactor Other <br />Pedestal Dbrrmmlom WM _ R It Thi* in : ChAW Bot Pipe <br />pump Submatsibie Ttpbine 011ier HPPimp R Water Leval ft <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WR,L BE DOW M ACCORDANCE WITit SAN <br />JOAQLHN C9UtfTY ORDINANCES ATE LAWS. AND RULES AND REGULATIONS. 1 ALSO CrsaTW'fW MY REGUM LICENSE IS <br />CU AND ACTIVE WRH CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM N COMPLIANCE WITH ALL <br />noN u <br />/ IM UM 24 HOU C E REQUIRE FORQIrSPE/CT10MS - /P� E CALL (209) n -7697 AJ <br />SIGNED' 1 :1 <br />C / <br />PAYMtn <br />RE�EN E <br />.AUL ®� 2 <br />SAN JOAQUIN Ga Aeon Arrxpted By <br />HFp�IRONMEl+ <br />W DEPARTMFN7 Grout Inspection By <br />Pump tnspectm By <br />Soil Bonng Insoeraon By <br />COMMENTS <br />TMENT U E PNLY <br />Date <br />Date <br />Date <br />HEALTH <br />Aree4k_ 6nPbyee lDa �1'I SLi sv dVwS <br />Well PetTtl3t � to <br />Ctanshvard VAd Depth ft <br />EM' :1-0h WELL RUr3P FERUFT <br />4130,2 <br />