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1681 "N Md :8 1101 'ql 'lIr aUil PaAia�a� <br /> SAN JOAOUIJr COUN7YEYVIRONRfFSJTgE HEALTH DEPgR WELUPUMP PERMIT <br /> MENT <br /> NON-REFUNDABLE PERMITCALL 'B6S� � <br /> TH4 --ro A S,,,,,,CA 95205-(209)46"420 <br /> JoJJADDRESS 203 953-7697 FDR INSPECTIONS 6760 R t 4 E-XPIRES 9 YEAR FROM DATE ISSUED <br /> }�w y <br /> Gillis CrTrrZrP Stockton sub <br /> CRASS STREET ApN 17 9-0 2 0-p 4 D <br /> F J S R PARCEL S�/D USE APPLICATION T <br /> OWNER NAME n�1 pa n c h e s L P <br /> OWNER ADDRESS 2928 2 8 D w i g h tala y r� PHONE <br /> CONTRACTOR Purvi ance ?1ril lens, inc. 0"STwT5/2rP"t O c k t O n r CA 957 /. <br /> p <br /> CONTRACTOR ADDRESS <br /> P. O. F30x 64 PHOVE 209-887-3554 <br /> � <br /> SUBCOIJTAACTOR � <br /> c-jSrATLinden, Czk 952-3 <br /> SUBCONTRACTOR ADDRESS PHONE <br /> CJTY/STAIPJZIp <br /> '-'aENSE L G57 _G61 i-D-Q9 3 7 7 9 2 3 ON ATE <br /> --�— 9 2 3 D <br /> GEOGRAPHICAL INFORNgTON: Coordinates X KUMBFJi <br /> IrtTENO®UseY Township__ Range-----. =DomestiUPrhrate IrrigaliorUAgricultual L Industrial 9 Section_ <br /> PublicWater System D WaterOualityMonitoring 'SoilSomplinc/Charact <br /> .ICAlarent bora Qxncr a talion <br /> a er ys em arnc <br /> _TPE OF W _INavWell eqr or one roper <br /> Replacement Wen Well AlteralloldModiNcahon 011ier <br /> fst-Raring wail(s) T of wells Sal Bonng(') <br /> Zorbor ry <br /> +Out-06Service Wefl Geotechnical aof 0a nys <br /> Out-0t-Service Well RenE.wal :?Cross-Connection Re <br /> New Pum P Re .cement _Pum Re air pair <br /> ng <br /> WELL C-----.,-uc oN =Raise Well Call <br /> Drilling Method Mud Rotary _Air Rata <br /> Proposed Well Depth R Rotary Auger Cable TORI _Push Point _ Other <br /> I Excavationc:am in diameter Open Bottom Gravel Pack/Gmve)Size <br /> CDeter r Casing in diamefer / n diameter <br /> Well Casio Conductor Cas ng Depth R <br /> 9 Diameter in 7hic�cness/GaugelAST1d Srhed —ft <br /> Depth R Steel Plastic =StainlessSteei =Other <br /> Neat Cement(94 lb bagJS70gal Kale <br /> Bentonite(2035 so&ds) --Other Sand Cement sack rnbd7 ga}%'rater <br /> IGrvut Placement Method Pumped _Free Falf <br /> Other�� L <br /> PERetardant/Ameletator(name) <br /> �n rat Installed By _Driller Rump Contractor <br /> Concrete Pedesal_Dimen.l. Width - Other <br /> R Length R Thiel: in Ctrristy Aox Store Pi <br /> Submersible Turbine pe <br /> =- Other. HP Pump Set <br /> nentm' CERTIFY THAT 1 HAVE PREPARED THIS APPLICATIOIJI REGULATIO ft Slartding Nater Level_ !I <br /> .IOAQUIN COUNTY ORDINANCES,STATE AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> CUR D ACTIVE WITH THE CALIFORNIA CONTRACTORS NSTATE LICENSE BOARD AND THAT T;4AAT I AM Irl REQUIRED <br /> CENWrH ALL <br /> LV <br /> KERS CO. SATTON LAWS, <br /> MIN 24 R VA E NOTICE REQUIRED FOR INSPEcMDNS-PLEASE CALL(209)9S3- <br /> ,7697,/ <br /> s1cNED ,2 rrttf Corporate SecretqT^Y <br /> F <br /> r <br /> SAN <br /> ..J <br /> Q I\J <br /> I G <br /> I ' � <br /> PART ENT USE NLY <br /> Application Accppted By <br /> �'C� / <br /> GrDuate f Inspection By Area 1/"/"1 Employee ltd `�tD <br /> Pump Inspection 13y !iD <br /> Date SPECIAL Well Permit <br /> Date <br /> Soil Boring I edion By tttt-����(( 0WavER Received <br /> OItil COMMENTS_ Dee C n cted Weil Depth <br /> PE SC Received Checitp! <br /> Codes Into g Amount Permit/ <br /> 19q Cash Remitted ate Service�Re Dest9 litvoice# Well lot <br /> C2 OD u I7 Y �)�Vi J 0 <br /> EM G1L6 <br /> 473q/1� <br /> ;YBLrRY:P PFlit-lr <br /> E•d t'ZSU-2860Z DUI SJejIiJQ 9OUeiAand d9L:E0 L 9 6 Inf <br />