Laserfiche WebLink
1 , <br /> B9 VIN AVR :: [ UR 'l 'ASA ;WIj paAI ;3;� <br /> f WELUPUMP PERMIT P ✓• 3 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTONAvENUE-STOCKTON CA 99205-(209)468-3420 <br /> NON-REFUNDABLE PERM CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRiSS 4944 Leonardini RD Cmzlp Stockton , CA 9525-hn <br /> m <br /> D <br /> CROSS STREET APN '/ PARCEL SRF LAND USE APPLICATION# o <br /> T n <br /> OWNER N0.ME J a t o sE Davis Jr- <br /> PHONE m <br /> OWNER ADDRESS 4 9 4 4 1 1,P n n P r d i n i R d Cl-IsTATEMP S t o c k t o n eC A 95215 <br /> CONTRACTOR Purviance Drillers , Inc PHONE 209-887-3554 <br /> CONTRACTOR ADURBS PO Box 64 Cr1YlSTATv7,pL i n d e n , CA 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE C 5T c s, D-09 o,ner NUMBER 3 7 7 923 EKPIRATION DATE 7/317i9 <br /> DOMESTIC WELLSAMPUNG:2 General Mineraltcoiiforrn Bacteria(4391)C Dibromochloropropane(4392)7 Arsenic(4393) <br /> INTENDED USE )VDDinesIctPrivale C Iniga11on/Agricul ural C Industrial n Water Quality Monitoring ❑ Sail SarnplingJChaloCerizafion ''11 <br /> u Public Water System <br /> If tlifferail tom Owne- V&W System Name Contact Narrow Phone Number ��rr►►rr,,l.� <br /> TVPEOFWORK O New%'Tall D Replacerrlent Well G Weil AitereionlMo k5cation 0 Other v O <br /> D Monitoring Weil(s) #of Wells D Sell Boring(s) A nt bwrgs G Geotechnical 9 of borings o? <br /> ❑Out-Of-Sertdoe Well C Out-01-Service Well Renewal ❑Cross-Connection Repair r/ '?0181 <br /> O New Pum Pum Replacement ❑ Pim Repair ❑Ralse Well Casin F Q(/�H <br /> WELL CONSTRUCTION �T .ONMECOVH <br /> ll <br /> Drilling Method n Mud Rotary n Air Rotary D Auger 0 Cable Tool D Push Point D Other FpgR�T,q� n' <br /> Proposed Well Depth ft Excalvaflon In diameter n Open Bcttom G Gravel Pack/C-rraM Size In diameter MFNr <br /> n Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameler,___,in Thick nesslGauge/ASTM Schetl L Steel 0 Plastic ❑Stainless Steel O Other <br /> Grout Seal Depth ft ❑Neat Cement(V4 1b baq S40 ge/water) 0 Sand Cement sack mcv7 gal water <br /> C Bentonite(20'%solids) ❑Other <br /> Grout Placement Method D Pumped n Free Fall D Other Retardant IAccelerator(name) <br /> PEDESTAL Installed By O Driller ❑Pump Contractor D Other <br /> D Concrete Pedestal❑Dimensions:Width R Length R Thick in D Christy Box D Stove Pipe <br /> PUMP Submersble❑Turbine I Other HP <br /> Pump Set ft Standing Water Level ft <br /> 1 HEREBY CER FY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQU IN 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 THATI AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> UM24 HO NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(204)953-7697 <br /> Sic �,T,�orporate Secretarll <br /> t 8 ' <br /> -411 <br /> I � <br /> - I <br /> RECE <br /> MAY Q NMEA LP TT <br /> PERMITS <br /> I <br /> I <br /> D AR BENT��USE/�O, LY <br /> Application Accepted By Dale Area Employee 106 <br /> Grout Inspection By Date ❑ SPECIAL We11 Permit <br /> Pump Inspection By Date 0 WAIVER Received <br /> Solt Boring Inspection By Date Constructed WeD Depth R <br /> COMMENTS <br /> PE Sc Received Chadd#/ I Amount PerrnW <br /> Into 8 Cash emitted Date Service uestI, Invoice# WeIIID# <br /> Z 0 <br /> 01043-08 aNLtfi '"")Q �/ <br /> /o (Q WELL IPUhIPPFJtUlr <br /> Z'd tZ5CZ9260Z outsaa11i.lQeoueiAand a£L; L9� 60AeW <br />