Laserfiche WebLink
VVELL/PUMP PERMIT <br /> SAv JOAQuIN Courtry ENNIRONMFINTAL HEALTH DEFT 1968 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468-3420 <br /> NON-REFUNDABLE PERRMIIT� �J¢CALL(209)/9y5}33-[7697 FOR INSPECTIoNs EXPIRES 1_YEAR FROM DATE ISSUED <br /> +JOB ADDRESSCITY/ZlP��r.. r �------ <br /> CROSS STREET (�""/'��/`^7 �•lw�,., APN �.{j , �L� PARCEL SIZE Zrf+ USE APPLICATION# y <br /> OYlNEA MRM£ `t.1�- [!L/�f_.0r6 f� PHONNE�/iS�TO j/_7 <br /> � <br /> .OWNER ADDRESS O %�y( yy AVE CITY/STATE/Z!P �4�!/rU <br /> �Co+rrxAcrcle (-'l L�et'l ��l�11.1�i���t,�..1 C' <br /> PHONE--d 7—r1� --- <br /> CaFtTRACTOR AUDREss t S_ Clrr/STATErZ a , y; 69i J w <br /> SUBCONTFAC-'OR ;=IiaNE <br /> SUBCONTRACTOR ADDRESS^ CRY/STATEIZIP <br /> UCENSE _ 1,15S 0 C-61 0 D-09 .�i Other NUXW.R__ A4__ ExpmAnoN DATA: Zk <br /> GeoGRAPHICAL INFO —N: Coordinates X Y Township_ Range Section_ <br /> I rEN p USE ' DomcstuJPrlvate rrigation Agriculh;ral 0 Industrial a Water Quality Monitoring ❑Soil SampiingiCharactarication <br /> Puoiie Water System <br /> j It evrw ys;emionzict Nar-i hnna u r <br /> TYPE OF WORK aw Weil 0 Replacement Weil S Weil AlteralionlModiiication 0 Other <br /> Monitor <br /> ng Well(s) Rol wells ❑Soil Sorng(sj "VSs Geotechnical aOry° "° <br /> G'Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> _ 0 New Pump .7 Pump Replacement 0 Pump Repair 0 Raise Well Casing <br /> WELT.CpNSTRUOTIIONN <br /> Uriiling PRothocI �vd Rotary C Air Rotary 0 Auger Cable Tool �Push Pont Other <br /> j Proposed Well Depth__ it Excavation _in diameter C Open Bottom ravel Pack/Gravel Srxe0II0'�._,? in diameter <br /> C Conductor Casing in diameter ) Conductor Casing Depth It <br /> Weil Casing Diameter�In I`kirie"'Gauge/ASTM Sched �C Steel C Plastic G Stainless Sloui ,;.;Othmr <br /> Grout Saal Dupp'��h'� C Neal Content r94 Ib bag(�70 gal crater) Sand Cement sock adi gal water <br /> (dri3cr;onin�l�20 ro sollds) C Other <br /> Iv ut Placemen,Method 0115umped 0 Free Fall 0 Other . _ 0 Retardant I Accelerator(name) _ <br /> EMUT-- installed By 0 Driller ump Contractor 'i Other <br /> Len0 Stow Pipe <br /> C Concrete Pedastal Dlmensiana:'N#th __ gth ft Thick—.—_-in 0 Christy Box <br /> �pUMp C Submemole0 Turbine Other HP Njrnp Set___It -Standing Wator Lave! <br /> I HEREBY CERTIFY THAT I HAVE PRFPARL-D THIS APPLICATION.AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUI.N COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> eiCRKERS COMPENSATION LAWS. <br /> MI UM 24 HOUR ADVANCE NOTICE R UlI E (INSPECTIONS <br /> DATE d�j <br /> i I VED <br /> I I <br /> r 2613 <br /> t'1V -OUMrr <br /> L1 IIAL <br /> I I r+arrvr <br /> I I I I i r <br /> I <br /> DEPARTMENT USE ON_„L _ <br /> Da4 _ AreaEmployee IDA <br /> ApVtI::aLor A:copted B I �,_ <br /> Grout fnspscion By � Daze !y S ECL WHIE Permit <br /> Pump Inspection By Date WAIVER Received <br /> "n,ingIn IBy Date _ C st led Well[Dooth <br /> l�I. tom <br /> _ �-of b r <br /> SC Recaivad Che5W Amount Per ,. <br /> Data G :, Well 14 <br /> uu.. Info B --Cash Remitted Service Ro ue:i,r9 <br /> ' «tt' 520 I -- <br /> I <br />