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9501 '°N WdSS : I L l 0 6 'Ll 'IPA auJi1 paAiaD;� <br /> WELUPU?VtP PERMIT <br /> t SAN JOAQUIN COUNTY ENNIROPAIEAITAL HEAL81 DEPARTMEN T 1 668 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.34213 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDReas 1 15 7 8 Sun R dh ` -P c1,TR,P'Stockton 95215 <br /> m <br /> ICROSS S,RE,r B e e c h e r RD APN V • V [/ PARCEL Sus-D IAND USE APPLYcAno.v m <br /> �OV+T+ERNAh1E Ott Barber � l in PHONE <br /> 2O9-662-1286 N <br /> 10%'VIJE-R ADDRESS 1 1 57P, Sun RD CII';STATEIZIP Stockton CA 95215- <br /> CONTRACTOR <br /> 5215CONTRAC OR Purviance Drillers, Inc- PHONE 209-887-3554 <br /> CONTRACTOR ADDRESS P. Oe Rox 64 C"iSTA-EITP Linden, CA 9523 <br /> iSUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS C17YISTATEIZIP <br /> LICENSE it C-57 _C-61 C-09 _Olher NuAmER 37792 3 EXPIRATION DATE 7/31117 <br /> GEOGRAMCALINPGRMATION: COO►dlrtateSX Y Township_ RSnge Seaton_ <br /> lo'LlmED Use aDome56crPrivate ::IAigagon)AgdoAbrtal 0Industrial 71'Nater Quality Monitoring Soil Sawpling/ChEamcIerizaEon <br /> Public Water System <br /> 1fCltterea:tmm Omer tar ys em e:ae rt yr aro mast <br /> t <br /> TYPEOFWDRx New Well _Replacement Well ::Well AlterallontUndifiraron Other <br /> MonitoringVVdl(s) Totvre'ds r:S0890ring(s) iotbadnp: - Geotechnical AoftorYps <br /> Out-OfService W I Out-OTSenBce'AA-11 Renemal I Cross-Connection Repair <br /> New pump Pum R iacement Pump Repair _Raise Weg Casing <br /> WELT.CON3TA UCTTON <br /> Drilling Method Mud Rotary _Air Rolary . Auger _Cable Tool _Push Point _ Other <br /> Proposed Well Depth it Excavation in diameter Open Bottom = Gravel PaydGravel Size in diameter <br /> Conductor Casing in diameter ! Conductor Casing Depth ft <br /> Well Casing Diameter_in TNdcness/GaugeIASTM Srhed Steel :plastic SlainlessSteel :!Other <br /> Grout Seal Depth R _Neat Cement 194 lb bag15-10gal Haler) _Sand Cement Sack nrtxO gal%valer <br /> -Benionitel20%soltds) Other <br /> Grout Placement Method -Pumped -Free Far ZOther 4Relatdant/Accelerator(riarre) <br /> PEDESTAL Installed By =Driller 7 Pump Contractor C Olher <br /> Concrete Pedestal--D1"sions:V•hdlh 9 length R Thldc inChristy f3o1c Stove Pipe <br /> haie jP Submersible.:Turbine !:Other HP Y PurrPo SP1 it Standing Water Level R <br /> l <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DOM IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS_ I ALSD CERTIFY THAT NY REQUIRED L=ME IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT t AM IN COMPLIANCE WITH ALL <br /> NIOR NSATION L A <br /> 28 D NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNE T ;.E Corporate Secreta.�V 7 <br /> PAl <br /> AYS yE <br /> RE�ENAir <br /> ( SAN ???V, <br /> COU <br /> � I I � H�TMOfaMp�ql� <br /> p � � MftiT <br /> I � - <br /> i <br /> CE'VED <br /> � <br /> l ' AR i 201? <br /> f <br /> I ! ENTAL HEALTH <br /> I I IMtTJSERVICES <br /> EP RTMENT USE N L Y <br /> Applicalian Accepled 6K '�;IMAI -f <br /> Date / Area Employee IDI ip <br /> Grout Inspection By Date1 :2 SPECIAL Well Permit <br /> I <br /> Pump nspecffon By Dale {' 75 WAIVER RBCeived <br /> Sail Boring Irspeellpn By Dale / Constructed Well Depth Y. <br /> COMMENTS <br /> PE SC Received Check,14 Amount Doto Pearitl Invoice# Wall tt31P <br /> Cotler Into a Cash Remitted Service Request'. <br /> 6&)D?70 . � � ✓tr <br /> i <br /> SMD X3-06 D/�O��J :•IDLE/PL..D Pr-FIhT <br /> er3eltz <br /> Z-d VLSCL9260Z out saellij4 eoueimnd dZ9:80 Z0 91,100 <br />