Laserfiche WebLink
1 Co <br />yfynm> <br />O <br />7j v <br />Ogg <br />M 21, c_ <br />=au <br />zr'z <br />—+ < <br />M <br />rr� <br />m (. <br />6EWIN Mq:q 9106 9WIJ paAiaaa� <br />WELLIPUMP PERMIT <br />SAN JOAOUIN COUNTY ENVMONMENTAL HEALTH DEPARTMENT 1868 EAST HATFLTON AVENUE-STOCKTON CA 95205 - (209) 46$3420 <br />NON-REFUNDABLE PERAIIT CALL 209) 953-769TFORINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 23150 "IT Johnson Rd cmlziP Clements, CAS_ ?7.7 <br />CRoss STREETHwy 12 ADN 023-280-08 <br />PARCEL SIZE � . � o USF APDL �A.,aN #OWNER NAME Good Earth Farms PHoNE2 O 9 L6 0 I --6 1 <br />OwNERAon,.175 Enterprize Crt arnsTA,E,z,PCa_lt . CA 95632 <br />CONTRACTOR Purviance Drillers, Inc. PHONE 2n9-887-3554 <br />CONTRACTOR ADDRESS P- 0- B o x 64 cITVISTATTJZJP T, indent, C 11 9523 <br />SUBCONTRACTOR <br />PHONE <br />ICOW ACTOR ADDRESS <br />ENSE M G557 " G61 D-09 J Olher <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />Cr Y1STATEOP <br />NDMBER <br />377 9 2 3 <br />EXPIRA-noN DATE 7 / 31 / 1 7 <br />Township_ Range - <br />Section_ <br />w a„gauu-9"cunurm Indusldal - Water Quality Monitoring I'- Sal Sampling/Cheraeterizallan <br />.: Public Waler System <br />Cd:rremm from o^er ate( ys em a"na a me or na umoar <br />r —h LrF wOHK W rveW well L Replacement Well 1; Well Allerationl'Modificalion a Other <br />Monitoring We;l(s) A of wells I ; Sol Boring(s) a or 15oo"9s r Geotedtnlcal A orbonngs <br />1, Out Of -service Welt— ^ Out -Of -Service Well Renewal ^ Cross -Connection Repair <br />:Drilling Method i Mud Rotary Air Rolary.ug <br />Proposed Well DeptnQDO ft e Cable Tool Push Pant a 011ier <br />F�ttavatlon If in diameter f Open Boltom = Gravel Pa&JGravel Siza <br />in diameter <br />CoRdudor asing In diameter I Conductor Casing Depth ft <br />Well Casing Diameter in Thidmess/Gauge/ASTM Sched , 26Z At Steel O Plastic - Stainless Steel 0 Other <br />Grout Seal Depth 100,0 fl 0 Neal Cement (94 1b bag' -510 gal water) it Sand Cement 16L:3 <br />r Benlonite (20% sol ds) ri Other sad* mix/7 gal water <br />Grout Placement Method z Pumped D Free Fall = Other G Rel erdantIAcceseratot (name) <br />PGUESTAL Installed By _ Driller E Pump Contractor Cs Other <br />L Concrete Pedestal Dimensions: Width R Length 11 Thick in Christy Box J Stove PEpe <br />PUMP _ Submersblet., Turbine i! Other HP Pump Se l ft Scantling Water Level 1l <br />I HER CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL 8E DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS_ t ALSO CERTIFY THAT MY ACCORDANCE <br />REQUIRED VVIT SE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND. THAT t AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />Um ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 963-7697 <br />SIGNE TITLE Corporate SecretaXV 10 / 11 / 1 6 <br />D <br />O <br />H <br />FPTMENT SEC <br />NLY <br />Appftcatien Accepted Btu A ,1 Date Area Employee IDrr_��"TC <br />Grad Inspection By Date D SPECIAL Well Permfl: <br />Pump Inspacgon By Date O WAfVER ReceiVed <br />Soil Baring Inspection By Dale Constructed Well Depth fl <br />COMUENTS <br />w <br />c.1 <br />a <br />LTH <br />+net 1 WELL rPU1P PERrrrT <br />Z'd tZSCZ2960Z <br />out saelp(i eoueiAand dL0:0L ZO L L AeW <br />