Laserfiche WebLink
LLIti "N AVtiS :O[ G [06 'S6 'd1S aulil paAI ;3;� <br /> • WELUPUMP PERMIT <br /> SAN JOAGUWCOUNTY ENVIRONMENTALHEALTHDEPART„E r IBS13ESTHAZELTONAVETIUE-SrocKTonCA95205-(29S)46a-3420 <br /> NON-REFUNDABLE PERkJfT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 14'0" 040 Brandt Rd cjTyjzPLodi 95240 <br /> CROSS STREErC 1 ILII e n t S R d APN O - PAReEiS LAND USE APPLICATION.9 <br /> A <br /> OWNER N=F Jerry P r o t z 16TSALOPKDrr>`l i n—7 n U_n 1 7 � N <br /> OWNER ADDREss 1D64'0 Brandt Rd _ C-/STATVZrP L o d; (:A 4 5 / <br /> CONTRACTOR Purviance Drillers , Inc PHave 209-887-3554 <br /> CONTRACTDRAIDDRESa PC) Box 64 C ,ST„E,�PL i n d e n , CA 95236 <br /> SueU MTRACTOR PHOhm <br /> SUBCONTRACTOR ADDRPSS. C1TYISTA7E1ZP <br /> LICENSE X C-57 U C-61 a 0-C9 o other Nu.7 3 7 7 9 2 3 EXPIRATION DATE 7/31 /19 <br /> DOrr.E9TIC4t(E3-LS"IPUNG:��General Mlnenal/Cafffonn Sactexia(43.91.,):.-Cibromochrore propane(4392)=Arsenic(4393) <br /> INTENDED USE jFCOMSSUdFrivale c IrrigaGoniAgdcullural C Industria{ G Water Quality Morvtodng n Sal S2mpfing1CharacterazSon <br /> C PubRoWater Sy3tem <br /> f 07i rd from Owner. Wafer System Nartre Cmlxct Marts or Poore NamCcr <br /> TYPE OF WORK ❑New VJeH C Replacrmenl Weil G We AlteralionffdOdffiration .3 Other <br /> O Monitoring Wells) #Of weds G Soil Baong(S) ealoanngs C Geotertmical 2WA-irrg: <br /> 4 Out-O(Savite Wdl G put-Or-Sendee Well Renewal 7 Cro5s-Connecl[on Repair <br /> C New Pump XPump Replacement t'Ptunp Repair 0 Raise Well Casio <br /> rWEucnojethod C Mud Rc tory r A r Rotary 7Auger 7CableTool ?Push Point ❑ Other <br /> WPII Oeplh R E,wavation in diameter _Open Botlom C Gravel PacIdGrdvel Size in d 2rneler <br /> 0ConductorCasing in diameter f Conductor Casing Depth ft <br /> Well Casing Oiameler_in Thic'vresslGaugelASTM Srhed _Steel C Plastic `Stainless Sleel G Other <br /> Grout Seal Depth ft 0 Neat Cement(94 It baWS-10 yal wa” G Sand Cement sack rnbU7 gal water <br /> D Bentonite(2D%sorids) :1 Other <br /> Grout Placement Method G Pumped 0 Free Fall 7 Other :7 IZelardarrt)Aocelerator(name) <br /> PEDt�7at Installed By 13 Drg(er 0 Prnnp Contactor Other <br /> O Concrete Pedestal CDlmensions:Width ft LengtA R Thick in D CTrristyBox O Stove Pipe <br /> PM SuhmersitleO Turbine Other HP pump Set �ffftn Slartding WalerLevPJ it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL IRE DONE IN ACCORDANCE WJTH 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 COtdrRACTORS STATE LICENSE BOARD AND THAT 1 AIN IN COMPLIANCE WITH ALL. <br /> WORKERS COMPENSATION <br /> MINIM �M 24 R CE NOTICE REQUFRED FOR INSPECTIONS-PLEASE CALL(209)953-7657 <br /> BION T,-,,forporate Secretar&,E <br /> I <br /> If V <br /> f <br /> I <br /> I I <br /> Y�ENT <br /> I i1 \1--Jl <br /> ��VFD <br /> " 8 2418 <br /> " I <br /> ME OUIV7y <br /> AtI <br /> I " �AR MFNT <br /> I <br /> J <br /> P � T M E N TU E 0 Y -►,6f,��-�/-�-/f�%� <br /> Application A.ccepled By le � Area <br /> E-plcy—iM <br /> GroutInspection By Date � SPECIAL VV01 Pt3rmit <br /> Pumo Inspection By Dare (� I(i1J -7 WAIVER RCceived <br /> Soil Boring Inspeclion By Date Constructed Well Depth it <br /> COMMENTS <br /> PE SC I Received CheckfN Amount Peralu <br /> Cod _. Info Cash _ _mitted Date ice Re uest# nvoicr X wen ILXq <br /> I <br /> er.D<ar_ enrns �� tiv=uptr,�P;�ur <br /> Z'd VZS£Z2260Z out SAGII!AQ aoueiA,ind e8Z:0L 26 SZ deS <br />