Laserfiche WebLink
Wti 'ON AVS0:H 8101 'Ll 'daS ;JJII paAI;3 <br />WELUPUMP PERMIT P ✓ ' <br />SAN JOAOUIN COUNTY Ewrir ONMENTAL HEALTH DEPARTMENT 1a58 EAST HAZELTON AVENUE - STDCKTON CA 95205 - (209) 463.3420 <br />NON-REFUNDAULE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Igoe AaoFtFm 9 0 5 3 E Hwy 8 8 clTYrz,Q S t o c k t n 9 5 215 <br />EI CROSS STREET APN6ff!:O PARCELS USE APPUCA71ON11 <br />m <br />n <br />o <br />7 n r <br />�OWN7tNAM L P 6bli id/C Y b0r'-e1)1t 9 — <br />iiii PF[ON '7 — <br />OVMFR AODResS P. 0. �B o x 4 51 1' u <br />� � �r7YrsTATErz,P <br />m <br />CON-MAcroR Purviance Drillers, Inc PHONE 209-887-3554 <br />Cate <br />CoNTRACIoft ADCRESS PO Box 64 QTY/SIATEIZ,PL li n d e n, C A 95236 <br />5U8C0VrRAC7OR <br />PHONE <br />SURCDNTRACTDR ADDRESS _ _ Crrr1STATFl6P <br />LICENSE X C57 U G81 ] D-09 D OtherNUM1tet-R 3 7 7 9 2 3 ExwitAltON DAZE 7/31/19 <br />DomEsTtc WELL SAfAP1111G: ^_ General MineralIcnlifcrm Bacteria (1391) _ D,bramcchloropropane (4392) = Arsenic (4393) <br />INTENDED USE D DcmestictPrivate inigationbNOCulturel G Indusldal G Water Quality Mordloring n Sail SamplinglCheraclerimtion <br />C Public WaferSy3tem <br />IrdlRemnt(mm Owner Mhw System Name CAn(x�ntame or PRcnc Numner <br />I VPC OF WORK :l Nev! Well C Reptaternent Well 0 Well AlteratioNModificadon ] Other <br />0 Mcnitoring VYell(s) o(wells G Soil Boring(,) 0 °f Honngs D Geotechnical 301Doddgs <br />D Out -Of -Service Well C Out -O€ -Service Well Renewal 7 Cross -Connection Repair <br />Drllling Method D Mud Rotary G Air Rotary D Auger 0 C2Dle Tool LI Push Point n Other <br />Proposed Well Depth ft Excavation in diameter _ Open Bottom C Gravel PacVGravel Size in diameter <br />U Conductor Casing in diameter r Canductor Casing Depth ft <br />Well Casing Diameter_ in ThicknessfGaugeIASTM Srhed = Steel 0 Plaslic D Stainless Steel D Other - <br />Grout Seat Depth ft G Neat Cement (941b bag3r0gal wafer) C Sand Cement Sock mixl7 gat water <br />C Bentonite (20% solids) ZIOther <br />Grout Placement Method G Pumped C Free Fall 7 Other C RelerdardIAccelerator (name) <br />�rEOE21TAL Installed By 0 Driller D Pump Contractor 0 Other <br />OConcrete Pedestal rDlmensions:VVdltt K Length RThick in -I Christy Box OStoveP[pe <br />PUrtiP D SuDmerSbI Turbine 7 Other HP Pump Set fl Standing Water Level <br />I HEREBY CERTIFY THAT I VE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />T„corporate SecretarfpATE 9-i 7-/j7 <br />Application Accepted ey /t'- itiij.2 <br />vim+ Date/ Ir <br />'�— <br />GroutlrspecRon By <br />Dale <br />Pump Inspec§on By <br />SDil Boring Inspection By <br />Cate <br />COMMENTS <br />S)0 `IVF <br />"rO —1 81QJ8 <br />p'yFiy�VN�y <br />Areat!(� Employee lEWMZ / <br />3 SPECIAL Well Permit <br />0 WAIVER Received <br />Constructed Well Depth R <br />Z'd VZ9£Z9960Z 01-11 SJ811!1Q aOueiA.lnd e9£:OL 96 Z6 daS <br />