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PA <br />RE <br />s#N <br />SAN JCAOUIN COUNTY ENVIRONMENTA'L <br />// <br />NON-REFUNDABLE PERMIT RY <br />L6 W I N Wd90:ti 2[06 '[6'2ny ;wll paAI;3;d <br />WELUPUMP PERMIT <br />DEPARTMENT 1868 EAST HAZELTorl AvEMUE-STOCXTON CA 95205 - (209) 4683420 <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROm DATE ISSUED <br />oB AODRess r'}i1 cl J/�(1�� �(1 I V/1 -T -r-, I— LSI . _ CITYIIZFPP11 1 1 VN IVT 1, \ ) kJ/ I <br />CROSS STREET Fr�.� ill tel/ VAPN lob-549-0PARCEL SIZE ff ' (LAND USE APPLICATION 4 <br />OWNER NAME Bonner Mendez PHONE <br />OWNER ADDRESS P U- B o x 126 CIrY1STATFJ7JP L i n d e n Ca 95326 <br />COrITRACTOR Purviance Drillers, Inc PHONE 279-887-3554 <br />CONTRACTOR ADDRESS p 0 Box 64 CITYrSTATFJZIPL i n d e n, C A 95236 <br />SUBCO.NIRACTOR PHONE <br />SUBCONTRACTOR ADORESS CIIYfSTATEIZIP <br />(LICENSE C-57 U C-61 Cl D-09 D Other NUMBER 3 7 7 9 2 3 E%PIRA-rod DATE 7/31/19 <br />nnmp--nr-UtIFI I Sawl-Lme: 7 General Mineral/Coliform Bacteria (4391) L Dibromochloropropane (4392) -Arsenic (4393) <br />WENDED USE D Owres UciPrivate IrrigaUon/Agricuftral O Industrial C water Quality Monitoring I, Soil Sampling/Characterization <br />0 Public Water Syslem <br />If diAerem hum OYmtr, V/alerSyalem Nems Corot f." or Phone Number <br />TYPE OF WoRn D New Well i Replacement Well C Well Alteration/Modification n Other <br />G Monitonng Well(s) MoTwells C Soil BOnrng(s) 001130dngs t, Geotechnical not Oonags <br />G Out -Of -Service Well pi Out-Of-Senrice Well Re�nreNall ❑ Cross -Connection Repair <br />G New Pumo D Pump Replacement unlp. Repair r�N-��`" G Raise Well Casing <br />Drllnng Method n Nlud Rotary 0 Air Rotary 0 Auger ] Cable Tool n Push Point C Other <br />Proposed Well Depth ft Excavation in diameter i Open Bottom n Gravel Pack/Gravel Size in diameter <br />ri Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thidmess/Gauge/ASTM Schad J Steel 7 Plastic C Stainless Steel '0 Outer <br />Grout Seat Depth It ❑ Neal Cemera (84 lb ba_gS-io gal watef) U Said Cement sack atixn gat vialer <br />0 Bentmite(2D%solids) J Other <br />Grout Placement Method 0 Pumped D Free Fall D Other C Retardant/Accelerator(name) <br />PEDESTAL installed By 0 Driller '1 Pump Contractor G Other <br />DCancrewPedestal❑Dimensions:Wdlh ft Length (ITtick in nChristy Box 7Stove Pipe <br />PUMP 0 Submersib{ urt re 0 Other HP _ Pump Set It Standing Water Level I j <br />I HEREBY CERTIFY THAT DAVE PREPARED THIS APPLICATION AND THAT THE WORK MILL BE DONE IN ACCORDANCE WETH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE VWTH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />MINI H V CE NOT)CE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITLQorporate Secret. r& —i <br />�J <br />0 <br />A <br />N <br />p RT ENT USE ON Y— <br />e `QjJ <br />Application Accepted By to Area Employee IDtlt �. <br />Groul Inspection By Date 2 / fr J PECIAL WAIL Permit <br />Pump Inspection By 'w II "V`�` }�WgIiODtl I { �• f IM �� WAIVER Received <br />Sal Boring Inspection By pate p Constructed Well Depth It <br />COMMENTS N v C i� r Gl to t� l.O ✓VJc� h 'Z d C7 <br />EHD<}pE aN1116 / U zo? / / 3/ WELL /PUMP >FiiNl: <br />£'d VZ9U9960Z out sielp(] eoueinand dot:£0 9L LZ 6ny <br />,1IA�. <br />/� <br />W_�1�'Ji���►i��1��1��IJI7 <br />EHD<}pE aN1116 / U zo? / / 3/ WELL /PUMP >FiiNl: <br />£'d VZ9U9960Z out sielp(] eoueinand dot:£0 9L LZ 6ny <br />