Laserfiche WebLink
M0 "N 090 : 01 flH awil paAl ;);� <br /> VVELUPUMP PERMIT <br /> SAtl JOAQUIN COUVTY Ev»IPoNmEaaTAL HEALTH DEPurtnaerr 1868 EAST HAZELTON AvFNuE-STDcttrviw CA 95205-(209)4683620 <br /> iUON-REFUNDAatE PERMIT` CALL 209 953-7697 FOR INSPECTIONS EXPIRES Z YEAR FROA1 DATE ISSUED <br /> JOBADDRESS qa i <br /> \ Cr7v178/� <br /> CR ors STREET g4kAPIN "OR —+PARCELSIZSO r v M ULE APPLICATION 9 c <br /> Ot7NER NAME Vk,C)NZQ k117% IMA <br /> ` A PHONE r �? <br /> OWNEfi AOI1R ��`'/��d,�E5 '3\ � )6_ `MA Cl7Y($7ATE17uP li <br /> �COIXMACTOR Furviance Drillers , Inc PHOgF 209-8?7-3554 ••• <br /> ICP;nRAmRA!3mtFss PO Box 64 0TWSTATUMPL i n d e n , CA 95236 <br /> �Su BcoNTHACMR PHOKIE <br /> SuUccw tpcTon AOD4Ess C"STATEOP <br /> LICENSE X C-57 u C-61 D D-109 0 Omer NumsER 377923 EXP$IA-noli DAr. 7/32/19 <br /> DnriE87tc t_NEtiSAmPuNG-_C General NfinerablColiform Baruria(4399)—_DdTromoch(oropropane(4392) Arsenic(4393) <br /> IMENpED USE DomastirJPrivale G Tniga1ion(AgrioulturW C Industrial C%Nater Quality Mwilaring D Soi3 SampfinglChaactetizaGpn <br /> C Public Water System _ <br /> tfd'JfeMMrnm Crmer- VV_er Syslu.Ka a Cyv:r�ntTr�or Ptron_HuTIlzr <br /> 1TYPEQFLyow (9 Nerrwell :ReolacententVYell C Wel AlleratiorAlodifin5m 0 Deher <br /> 0 h;onitorin!)Well(s) A of wells G Spy 6aing(s) z or'onms C GeoleUmicaf � n _ <br /> L?Out-orS6re Sen <br /> enWell C Out-OfWet Renev at o!Cmss-Coanecfion Repair A <br /> 0 New P[cn C Pump Re [acerr,ent •Purnp Repair Raise Well Casincl <br /> WELL CONSTIIULMON �, PA <br /> Dr1111ng Method ❑Mud Rotary C AfrRotary :)Auger 7 Cahle-col 71 Push Point D Cther <br /> (Proposed Well Cepth It ExcavzG4on in diametar _Open Botlom C Gravel PacJdGravel Size in damater <br /> Well CaslnD Conductcr Casing in diameter I Condu=r Casn9 0epLi ft ' 32018 <br /> Cgmefer_in Thirlmess/GaugeJASTM Srhed ic D Sled 3 PlastStainless Steel 3 01her <br /> Grout Seal Depth ft O Neat Cement(94!O Oao'5-10 gal rrarej) 7 Sard Cement sack mkR gt+ll� ONM CpIJN <br /> .9 <br /> e aer,tonae(2(xs solids) _'J other DEp 'A, <br /> At <br /> Grout PlacementMethnd D Pumped 0 Free Fall J Other a P.eUudantlAccelerator(rrartte) gRTtijFNT <br /> Pr�Egigl Installed By 0 Driller D Purnp ConLador 0 Other <br /> 0 Concrete Pedestal LDimensions-VViXi f; Lergl fl Thick _in -IChristy Boo: C Stove PIPL <br /> PuntP ■5ut;me.SIDlen Turbine D Other HP Pump Sfe R Standing Va2ter Letie f( � <br /> 1 HEREBY CERTIFY THAT I HAVE PRED PARED THIS APPLICATION ANTHAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUfN COUNTY GRDINANCF.S, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT 1'AY REQUIRED LICENSE fS <br /> CURRENT AND ACTIVE WITH THE CA-IJFORPIIA COrD-RACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL : <br /> WORKERS COMPENSATION. S. <br /> l7fNIM 24 qn, VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7fi37 <br /> sten T,,.,orpoTate Secretarbr,L 1p-23—, <br /> 11 i <br /> PH+ <br /> I I i <br /> I <br /> 11 I I I f <br /> 1I I L I I I I I I I I I I I <br /> I I I I I <br /> I I I <br /> I I II I <br /> I E d <br /> I I t I I <br /> I f I I <br /> I I I <br /> I <br /> ER7MENT U E V <br /> Appliicaiion Accepled Sy Data Area Employee 1139 <br /> Grout Inspection 9y Date 71 PEc1AL Well Permit / <br /> Pump Irspecfion ay V\NNaZv Dale %j 2 (1 ( 2 UVAwm Received <br /> Soil Suing Inspection By Cate Constructed Well Depth It <br /> COMMENTS <br /> PE SC Recoived CheceW Amount Permi7 <br /> C s-I Info_._ __By ___ Cash ._ Remitted Date Service Request# InvpfrrlF Well ltd <br /> i <br /> G`0434� enxra �,/ (�� vrzi1 nu_r pERurr <br /> Z d bL5EL8860Z / oul well!.)(]eouelnand P-ZC 60 9 L 8Z l00 <br />