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WELUPUMP PERMIT <br />3m JOAOIAN Couem Ewamo axTAL HEALTH DE►AATIIFJR 1191 EABT HAaLTON AVENUE - STOCKTON CA 96206 - 121111111),0166 414=1 <br />NON-REFuNoAeu PERwrT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISsuEO <br />Joe Awma 2640 E. Lafayette Street (Kirg Elementary, <br />pryer SEodki&M206 <br />CAousTREET Sequola Court � �Vt APN <br />PARCELSDA IO Um Amr-mm <br />Stoddon Unified School District <br />P„ (209)...933-7000 <br />CVAMR NAME <br />_ <br />OWWR ADDRESS 701 N. Madison Street <br />C"yr*TAwrzp Stockton, CA 95202 <br />CONTRACTOR Woodward Drilling Co., Inc. <br />pl.I M _ ..OT) 374-4300 _ <br />550 River Road <br />CrTYISTATIMP Rio Vista, CA 94571 <br />CONTRACTOR ADOAw _. <br />i <br />3UAcONTRAcTOR %BOTe- <br />ryy� <br />.. Pharr[ —(9�T7 ' '�`^� i <br />�rAA N la V <br />301000NTRACT011 ADM k �' <br />CrTrASTAT[!b 8016.01 eA - <br />LICENSE O(C-67 C-6 t D4)9 DOW <br />mummA 710079 EXMAIM DATE -- - <br />Dowwnc WILL EAwuNo: G*nwd MvwW Cobfarm BscWW (4391) <br />(4392) :, Aroma (4393) <br />{�[ O DOmEMIdPrKmw c kivesonag uounal '- kxkwkw <br />vA" O m ky mwmwi g O 806 SrIIpIrt0lChratlarkaYon <br />❑ PNDIc Vrrisr System <br />� <br />rdar.«s Irrrw o..rr YVWr STsbr Nan. <br />e4whad Mean, w I•Irrw rte+« <br />T1mE OF Wom D NOW Wa8 n Raple. WN a Wd AM�raOaMhbdlra9orl <br />O 0*w <br />t':MorAortl YAWS)—_ idwells SWsorkp(s).. <br />aofb~ tICGeONdYtiCel_�_aSftMq► <br />khAOf-Service Wed twk-Of-� W W RrrrwwAl Cross Comscfbn RpAt <br />Now Puna Rum R*01sO wN Perp Rpt <br />R>h Wel Craft <br />DrW" Method !- Mud Rory At Rotary X Auw L Cable Tod Push Pdnt LJ 091w -- <br />Proposed Wel Depth 20 A FxeveYon S -kXh In dirrwter Open Bodorn ^ Graval PaddClr" Sita _ In d wmlw <br />CondudW CMhq ___-- n denwler / Condictx Casing Depth _R <br />WallCasing Dhrwbr _ n Thiclumm'GrpwrAST)A SChed Steel P1aS9e SMhle" Sbd 09tsr <br />Grout Seal Deplh 2_0 r R YNm _- wrur t (SL b D.yS-T0 pal r W.j Sand Cwnwt mck mkf1Val wdw <br />BarAmvi a (20% sobda Other <br />Groat Placeawnt Method Pumped Free FBI RsWrdwt IAoaelralar(fA M) <br />SBL MwfB9adBy Driller PtEnpCtlrtkadtlf O kit. <br />�_.. Concrete Pedestal Dkrwmions WM a Le11,1i Th" N Christy soli u ibw Pipe <br />SubrnwsibM Turbtw O9w HP Pum 5• R SWx&V Water Lewd R <br />I HEREBY CERTIFY THAT I HAVE PREPARED THE APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUN CIXINTY ORDINANCES, STATE LAMS, AND RULES AND REGULAMNS. I ALSO CERTIFY THAT MY REQOIRED LICENSE 13 <br />CURRENT AND ACTIVE WITH THE CALIFOitMA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />Ml UM 48 HOUR ADVANCE TTICE REQUIRED FO�f �ASPECTION - PLEASE CALL (209)•99553--77697 iT <br />�- t L. TrtLE L'Xr DATE /mac! �f1 <br />3$ <br />R <br />4 <br />Appk"- Ao-pied By <br />Grout lrmwton By <br />Pump Impscson By <br />Soil Borttp kapiNgon By <br />COMMENTS <br />— h��Ntr114 Qb, <br />qR MENT U E O L Nf <br />— A. �� Emp1oYN I lK <br />0 SPECIAL Well Permit <br />_ <br />Daft WAVER R9cWved <br />Date CormmKied Well Depth ft <br />EHD 41M mYM vrvu <br />