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TAIA611 5('AIn %-It-16106IM M[ '°N NVH: l [ 9[06 'S 'EnV MIM P;AI ;3;� <br /> OELLJPUMP PERMIT C 7 <br /> SAN.ICACUINCOa*trrENvntoranFrrrnr IIEALTHIIEPARTh�YT 4136ae"THAZEL.To.vAvEriUE-STOOKTONCASS20S-12D9)488-3420 <br /> NON-REFUNDASILE PER1,17 -CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> P. <br /> JOB ADDRESS 16900 E Ketcham LN cnyrlinden CA 95235 <br /> D <br /> 0 <br /> CROSS STREEJ'EAr—c h e r dale APN 1q 1 l 7V')0 k fto=Stzef2M LAkD USE APPUcAmom-A m <br /> OWNER 11MIRF'errari Farms INC PHONE-(209)662-0504 <br /> CIVIER 40DRE.ZS 17071 E Baker RD Cm/SrATEr ,i n rl P T, n q5 2 3�j <br /> ICUNTRAtTOR Purviance Drillers, Inc. PlemE 209-887-3554 <br /> COMMCTORAVORESS P. 0• T�oX 64 c lSTATerl, Linden, CA 0523 <br /> SUHCOMMU=11OR PHONE <br /> SuaconsrRAGToR AooRess CITYJSTATerda <br /> Licayse L 457 L"I D49 _othar NUMBER 17 7 9 2 3 E7IPJRATtON DAr 7 131 /'1 7 <br /> GEorRAPHICALINFOR44TION: Coordinates Y Township_Range Section_ <br /> ItrTE O OUSE '_DmneSSi 'Private ]InigatrcOJAgriculhual C ladusbial _tVra'.er Oualiity WrAtoring :7 Scil SamplInUtCharaderimtian <br /> Public VfaterSystem <br /> rralr%mrtdam Ovmor_ er ys ertr +rc �omaa.arm or one u.•rmer <br /> TYPE OF WORK _Newwall _Rep!2cement Well _WPlI AlteraLionflAodiHcatien _Offiv <br /> Monitoring WelKs) mo(wella ;,SOiI Boring(s) 001eagngs _Geolechrilcal nal--ANS AC MEW7r <br /> Out-0CfWar ^Out-OfService lA/el.Rener mwal CrConnecUoa Repair ENE, <br /> New Pump WPL7np Re laconent 1:1 Pump Repair Raise Welt Casino <br /> VJELL CONSMUCT w1 <br /> DnTiing Elh <br /> leod _Mud Rotery Air Rotary _Auger i Catle Tool -,Push Point _I Olhef O 24 <br /> Proposed Welf Depth It Etccavaficn in diameter _Cpen Bottom =Gravel Pac cfGralel Size in diiam QUIN CoU <br /> Conductor Casing in diameter f Conductor Casing Depth n '`1 FAL DEP Eh7, <br /> Well Casing Oiameler__in 7Wcc'nass1GaugeJASTM Sched _Sleeil =r Plastic L Stainless Stat C GIhE-r o E1/T <br /> Grout Seal Depth It j Neat Cement(94Ib bagr_'T-10ge7t.,ate4 _Sand Cement sack nairJ7 gal IvaJer <br /> i Bentonile(20%safids) •�Other <br /> Grout Plaeementtrlethoti =Pumped Free Fall G Other C Relardant J Accelerator(name) <br /> PEOESM Irtstatled By ^_Dri'Jer Pump Contractor Other <br /> J_Concrete Pedestal_DimensionsWidth rt Length 3ThiCS In ;;Christye= UStow-pipe <br /> aurae _ r•Sub nersiDFe/Turbine r•Other HP 30 Pump Sel ft Standing VValet-Le l It f 5 <br /> I HEREBY CERTIFY THAT I HAVE PREPIS PREPARED Tin APPLICATION AND THAT THE WDRK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY MQUIRED UCZ_ SE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AM THAT 1 AM IN COMPLIANCE WITH ALL <br /> IJV)0 MFE3USATION LAWS. <br /> M UVA I bi0tJ1ADVAmrE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)853-7697 <br /> std �� TmE Corporate Secret �/ I <br /> I I <br /> �i <br /> i 6 <br /> 1 i <br /> h4f,PLY- <br /> OIL <br /> I l <br /> _ IV <br /> l <br /> I lilt <br /> RE <br /> r I <br /> 4-1 <br /> I l r , <br /> f <br /> ENVIROWEN EEFi ! <br /> PERMWS <br /> DEPARTMENT S N L Y <br /> i <br /> App�Ifon Accepted BY Dale � 1WArea Employee IDy <br /> Grout Fnspettion By. A Date O SPECIAL Well Pertrtlt <br /> O;p <br /> Pufasoerser,By Date D WAIVER Received <br /> Sall Boring Inspection By Date Constructed Well Depth _n <br /> COMMENTS -- <br /> PE $C ReceivedCheelUtl Arnovnt Permit/ <br /> OateItrraiceT tlfoil lob <br /> codes Inro By insh Remitted ServiceRertuest-A <br /> g� 1,AK ismD wia-tG 154007 5434 I9N�003�q <br /> za. 6973 7/� VALLIM31PPERMIr <br /> :rtr�,z <br /> L'd t'L90L8960Z oul sjell!j4 eouelA)nd d0£:90 ZO SO 1eN <br />