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• �� �`�`� WELL/PUMP PERMIT - <br /> -A JOAZUN C=,M EWR'ONMENTAL HEALTH DEPT 1668 East Hazelton Avenue-STOCKTON CA 96205.6232 • (208)468.3420 <br /> )NARFUNDABLE PERMIT CALL 206 953.7697 FOR INSPECTION$ EXPIRES 9 YEAR FROM DATE 15SUED <br /> oAaoaess 22176 SKIFF RD. CIrYfLP ESCALON 95320 <br /> 09481R�Ltr- YAK AT.t,gj`j S S• Ak 0 0 0 a PARCEL 8212- 58 LANG USE APPLICATION# <br /> VNER NAMI WAGNER DAIRY <br /> -� PHONR 209 652-5009 I <br /> VNL:R ADDRti8E �'AMF CITY/STATEIZIP <br /> I <br /> �NTRACTORemnc+umnh ARMATURE D MOTOR WOnv' <br /> Ertt Q, 209-4 6-9S27 i <br /> jNTRACTORADDRue 646_S: California Street: CITY/STATE/ZIP Stockton, CA 95203 <br /> 19CONTRACT41t <br /> PHONE � <br /> $CONTRACTOR AOORase CITYISTATE/ZIP <br /> SENSE 0 C-57 If C-61 0 D-09 0 Other Numm__72477$ EXPIRATIONDATE_ 08I�g <br /> t03RAPHICAL INPORMATION, Coordinaties XY Township ; Range Section <br /> rfm ED UeE 0' omeadclPrtvste A rrlgetlon/Agrlculturat 0 IndusWal 0 Water Quality Monitoring 0 Soil Sampling/ChareotertmtIon <br /> 0 Public Water System <br /> If PS <br /> er"from er. r <br /> rumm rang or mons rwirriver <br /> PB OP WOES 0 New Well 0 Replacement Well 0 Well Alteration/Modlfication 0 Other <br /> 0 Monitoring Well(s) #of walla 0 Soil Boring(e) R of ono' 0 Geotechnical *of Ar <br /> 0 Out-Of-Servloe Well 0 Out-Of-Service Well Renewal ' 0 Cross-Connection Repair �� •MIT <br /> ew um Pum Re acement Ra al Reis Wil Casing6zly <br /> °�CONSTRUCTION <br /> Illtng Method 0 Mud Rotary 0 Air Rotary Cl Auger 0 Cable Tool 0 Push Point 0 Other JUN 31___ _ ' V <br /> opoaed Wel! 0 Co it Etin In dlemeter 0 Open Bottom D Gravel Pack/Gravel Size "NJAQlp/� � <br /> 0 Conductor Casing In diameter / Conductor Casing Depth ft H—gq"�`T°MR-ANT <br /> Well Casing Diameter_-__In Thickness/c3augs/ASTM Schad� 0 steel 0 Plastic 0 Stalniess Steel 0 Other_,,, ART . <br /> Grout Seel Depth ft 0 Nest Cement(94 fb beo-10 gar water) 0 Send Cement sack mba7 gel water, <br /> 0 Bentonite(20%solids) 0 Other <br /> 'Out Placement Method 0 Pumped 0 Free Feil 0 Other 0 Retardant/Accelerator name <br /> .011" Installed By 0 Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedesta Dlmsnalone;Width ft .Lin ftThlok to 0 ChriAty B 0 Stove pipe <br /> i <br /> ,9ubmeralble 0 Turbine 0 Other �idF Pum 8N 1 ft Standin Vie <br /> Lade: <br /> HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE 1N AC 0)tDAN, WIT <br /> )AQUIN COUNTY ORDINANCES,STATE LAWS, AND RUL <br /> @S AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> ORRERY AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND 1'MAT,1 AM IN COMPLIANCE WMN ALL <br /> ORKERt3 COMPENSATION LAWS, I <br /> .--� w►aw # sA 1.1f%Lfr?11P11/AHI09 hl0'rit':F2 r4Ft;11111'?tf=t1 F"011 trkl'RPUl."fI0N,4 �( <br /> 81iiN�p - 'L''� 7h7 a CEO DA <br /> a <br /> �•, ,,, r:'e�lill <br /> -.*..-�Mgrs^--s�-•^- r--•-Tom+ � . <br /> MILKING BARN ! " t • PUMP/WELL Is located approx..Next to <br /> milking bam <br /> �'giY7e� <br /> CEhi "' ° <br /> _JJN �. <br /> P 1.E <br /> TMEWT Uss PNLY <br /> APPeeation Ao0epted By 01 _ <br /> °'a' EmpbyesIo � f <br /> Grout lnspecx[on By OOe 8pEGtAL V"P+irlttlt <br /> Pump inspection By OMs 0`� VIII <br /> SorkV <br /> Reaskmd <br /> C`+omme g Inspection$y Contructed Wou Depth <br /> tt <br /> PE viled Amount <br /> Codas MPo' a RsnNtbad Data Mwlos E V"V# <br /> 003?t p <br /> EHO 43.08 <br /> 8/04108 <br /> WELL/PUMP PERMIT <br />