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lnA�` 'lpSM <br /> WELL/PUMP PERMIT <br /> SAN JOA011111 CWNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HN LTON AVENUE-STOCNTOM CA 952H-(20/)46&5421 <br /> NON-REFUNDABLE PERMIT <br /> IS JI CALL <br /> 209 953-7697 FOR INSPECTIONS EXPIRES <br /> XPIRES 1 YEAR FROM DATE ISSUED <br /> JOAODREW E- IIAWy 0xo c, L Ndeo 95: 13G <br /> I <br /> CR016EET () t IIE ] Sd APN C16 'j-_t J0'!!L_PANCaSRE <br /> LAO LANDUSEAPPPNC�AJTIONi <br /> OWNER NAME t-- C C��MONE1 /' 1!7'ci <br /> OWNER ADDRE88 _I n ACJ li' I� V CRYISTATErbP �R I T /C A ^ ".G J <br /> CONTRACTOR \ 11 e y �']I J r 1 I I//��t'n�Ty pNPR, �7�JJ 7/9/ J <br /> CONT ctciR At1MEte�. o Box 4 d CRYISTATE/b G cOy I c'A —i 5 4'+J� <br /> SUBCONTRACTOR pHicissai <br /> SUECONTiMCTOR ADDRESS CITYISTATE OP <br /> LICENCE C-57 C-61 _D-W DNer NGMsl!14�xI1. -S E1V1MTIox DATe - , <br /> GEOGRAPHCALlNFO11MATgN: CWIdMMMX V TOWnohIP— Range_ $eaten_ <br /> INTENpED USEiIndustrial --Water Quality Monitoring -Soil Samping/Charederizetion <br /> PublicWaterSa Iier r ,. �n•� <br /> TYPE OF WARM New Well =Replacement Well -Wel PlteretioNTbdi ination -Other <br /> C Monilodrg Well(s) I of walls =Soil Boringsamlros s) _Geotechnical etl WdRP <br /> r Out-OfSeMce Wel Out-O/-Service Well Renewal -Cmss-ComMWon Repair <br /> XN"PurnpPump Replacement -Pump Repair Rttse Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Metho A Mud Rotary -Air R(MIy -Auger COW Tod - Push POW - Other 1114 . <br /> Proposed Wall Depth50C) It E wavason IA in diameter 7 Open Batton Y Gravel Pa&"avel S¢e_ _ diameter <br /> Conductor Casing in diameter / Ca1°3elr Casing Depth ft <br /> iam <br /> Well Casing Deter 3nn Thi krwN s/Gau9WASTM Sd*d -9Ll' -Steel ;(Plastic -Stainless Sleel -Other <br /> Grout Seal DepthGO ft -NOW Cement(94 1b 1561915-10 gel water) )(Send Cement 10 S sack mix/7 gal water <br /> �Berdonhe(20%sdids) 'L Olen <br /> Grout Placement AlamoO X Pumped Free Fel Omer _Ra rdare/AmelerelOn(n ) <br /> PEO ML Installed By Dmler Pump Co m;CW v ! ONer <br /> Concrete edesral-DMnenebns:Wxfth�ft Lengm ftThRit M ^ChnstV :Stove Pipe <br /> p -Turbine Other HP Pump Sel ft Stand WWrlevel h <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REWIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> sloNEn f a,-z c`+r TITLE J . (C r r S,Ct to DATE 17 1 <br /> W� e <br /> Irl <br /> ppYMEN S <br /> RECEIVE <br /> DEC 2 0 20 <br /> SAI EN p"'U0 ° <br /> HATolo <br /> H DEpA5 <br /> Z D. <br /> on <br /> P A.,RTMENT USE O Ly �y F6� <br /> ApplirstlAccepted B)' ZfE Data Ab'4 ! Employee IDIS <br /> Grout Inspection By Date 7 SPECIA W611 P917111ft <br /> Pump Inspection By Date 7 WAIVER R6eNved <br /> Soil Boring Inspection By Date Constructed Wel Depth ft <br /> COMMENTS <br /> PEC Rice ChastelyAmount Dab Penniv Mvdcei Well IDI <br /> Codes Info RMnI6M SeTvkeRequest 6 <br /> is b <br /> E1033-06 /Y�/� / WEiLRUWPERMIT <br />