Laserfiche WebLink
ti[D "N WdS6 :ti 0 E ';)0 aUJIl P;AI ;); <br /> WELLI'PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 7 <br /> EASTHAZFION AVENUE-STOCKTON CA 95205-(269)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUED <br /> 25® V Fscalon Bellota Rd CirylZip -2� ° <br /> Jae AoeAEss 6 � <br /> CR-s STREET Hwy 26 APN 6q.2-,—f70 -U�PARCELS�� - wOUsEAPPuCAncxA o <br /> omER NwaE Nor r N PHCRE 2rl9-8fi7—?nL5 <br /> OWNER ADDRESS R fi h 5` F 1)u>•a.t R d/P5 n� I cyTVIs�AT�ziP�a n (;a r i P i.__C A 91 7 <br /> CONTRACTOR Purviance Drillers , Inc PHONE 209-887-355L <br /> CVMACTOR AouREss PID Box 64 CmrrsTATEt2�PL i n den , C A 9 5 2 3 6 <br /> SUBCcWTRACTOR PHaNE <br /> SUBCONTRACMR ADDRESS Q7yjSTA7EQP <br /> UCENSE N G57 U Gs1 G D-09 D other NIM,eER 3 7 7 9 2 3 EXPIRATION DATE 7/31/19 <br /> DomEsmc>NFj-L SAMPLI=0 General MineralliCoGform Bacteria(4391)=Oibromochioroprapane(4392)=Arsenic(4393) <br /> INTENDED USE n Domestierprivale AlnigatfordAgricullLIral C Industeal G WaterQu25ty Manitunng rS SO?SamplingfChamcferiza6on <br /> L'Public Water System <br /> 1ddrer971%rn Ort , 'Nefersystwn Karts r.Of1I2A Name ar Pno�NamD�s <br /> T—OF Worm D Neri well C Replacement Well 0 Well XCradOnlModifinhon D Other <br /> D Monitoring Weil(s)w_#of Wass G Sao Boring(s) «o1°°1IIn' C Geolectinical satoor%s <br /> G Out-Of-Se W C.OW-Or-Service Well Renewal -7 Cross-Cormeclion Repair <br /> QPump <br /> New um Re facement C P Re air 0 Ralse Well <br /> !Wei CONSTRtrCTION �v <br /> IVnItIngMethad ClMud Rotary f:AirRctary 0 Auger D CableTaol D Push Point n Other <br /> Proposed Well Depth ft Excavation in diameter �-,Open Bottom G Gravel PacklGravei Size in dl 8 <br /> G Conducter Casing in diameter I Conductor Casing Depth <br /> Well Casing Diameler_in ThidatessfGauge/ASTM Sched =Sleel .3 Plastic C Stainless Steel D Other y �N <br /> O�HGrout Seat Depth ft 0 Neat Cement(94 16 tragi-tO gal warel) ❑Sand Cement —sack mbn 7 gal water �. <br /> D BentonTe(2a%se5ds) D Other <br /> Grout PlacementMethad G Pumped D Free Fall 3 Other 7 Retardant/Accelerator(name) <br /> P_mE esTxt Installed By D DrEW -0 Pump Contractor ❑ Other <br /> I C Concrete Pedestal CDlmensions:VYidVt h, Length f1 Thick fn '1 Christy Box 0 Stove P1pe <br /> Pua a ❑SLOrrersibirbire 7 Other HP Pumo S ft Srandi n°Water r eves n <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATiON AND THAT THE WORK WILL 13E DONE IN ACCORDANCE W'TH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS. AND RUI FS AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED UCENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE VMTH ALL <br /> WORKERS COMPENSATION <br /> MINI 24 ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(7,09)953-7697 <br /> sz�h 'Zorporate Secretary E/i9-�G iP <br /> i <br /> I ; <br /> I <br /> 1 <br /> i I I <br /> RECE <br /> OCT 0 4U 10, iL <br /> i <br /> I - <br /> ENVIRONMEN <br /> PERMITIS <br /> �t II I , <br /> AgTNU E ,N1�1rLY <br /> AppL'calidn Accepted 8y� I�-' !!�� Cale <br /> � V Area Employee tD#�� <br /> Grout Inspection By Date 7 SPECIAL We(I Permit <br /> Pump t2specion By APcQA bbO' -�V�tA Date `b I�1,/1 , ❑ WAIVER Received <br /> Solt Haring Inspection By Date Constructed Well Depth fl <br /> COMMENTS <br /> PE SC Received ChLICA14 Amount Date Permit Invofce� We3f iDk <br /> Codes.]. Info h ilted ce uest# <br /> 14-7-7 IWA <br /> E.O Ctc ening .4 OJ S/ T VTEELrr`t.PIP F.R'ST <br /> Z'd bL98L8860Z OU1 Slalll)Q 801,113IAlnd dL9:80 9 L 80 10 0 <br />