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A <br />RE <br />APR <br />WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNUABLE P t:RMI I UALL ILUIVI U04-/0yI FOR IN5PEGTIUN5 <br />tANIKtS 7 YEAR FROM UATE ISSUED <br />JOB ADDRESS 19535 S. CARROLTON RD <br />CITY/ZIP <br />95366 <br />CROSSSTREET WAGNER RD. APIN <br />PARCEL SIZE <br />!RIPON <br />LAND USE APPLICATION# <br />OWNER NAME WILLIAM SAARLOOS <br />PHONE 599.2729 <br />OWNER ADDRESS 19535 S. CARROLTON RD. <br />CITYISTATE/ZIP <br />RIPON, CA. 95366 <br />CONTRACTOR N & S IRRIGATION, INC <br />PHONE 209.599.3456 <br />CONTRACTOR ADDRESS 215 W. MAIN STREET <br />CITY/STATE/ZIP <br />RIPON CA. 95366 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP /� <br />LICENSE C-57 C-61 D-09 XOther C10 NUMBER 662732 EXPIRAnONDATE_ 0131/19 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township _ Range Section <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization pp�� <br />Public Water System is <br />If different from Owner: Water System Name eta Name or one Number <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification i Other <br />MonitoringWell(s) #of wells Soil Borin (s) #of borings Geotechnical #ofbonngs <br />41 <br />YMENr <br />' 1 <br />• . <br />monE., <br />1' • <br />• <br />•' . 116101 <br />• I • 'I II • • 1 ' • 1 ' ��, <br />IM k P51 JN ■NEEM■■■■■■■ <br />��,�■I�L�IG!■■■■M■■■■■■■■■Ml9iYfiiiii'■■ ■ail■■M■■■■■M <br />■■■■■■■■■■■■■■ ■■■■■■■■■It■■��!�EI■til■■■■■■■■■ � <br />PE SC Receiveda Amount Permit/ <br />C04445 -Info B ash emitted Date Service Request # Invoice # Well ID# <br />z�33s z3 �� w o3 i <br />EHD 43-06 WELL /PUMP PERMIT <br />4/30/12 <br />