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Apr 06 02 11:18p Purviance Drillers Inc 2098873574 p.5 <br /> T11-401k OA-1 <br /> WELLIfPUMP PERMIT <br /> Sm JOAaLmNCouNTY EN.7%CNFeENTALHE8LLrH DEPARTN.XT 1858 EASTHazmTaNAveNue-STocKro++CAS52D5-(2()9)4683420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES t YEAR FROM DATEISSUED <br /> m <br /> JosADDRESS MuP h Ir R d <br /> 9030Sr cmrzm Stockton CA 9521 5 <br /> -- <br /> CROs SIREEr M a r <br /> i p o s a RD APN� ' PARCFI S¢E r 0 UNo U7SEAPPL3CAATroN t m <br /> OV=R NAME Jim Luis _ _ PHo�C09-480-1 1 76 � <br /> ovrNrx AoaREss 9030 'M u r p h Y R d Cmr1sTA-mizilS t o c k t o n CA Q 5 9 1 5 <br /> CON-MACTOR Purviance Drillers, Inc_ PHO.X 209-887-3554 <br /> CONiRACTDRADDRE55 P. 0. T3ox 64 CITYISrA3E7ZIP Linden j CA 9523 <br /> SLIBCONTRACTOR Pli ONE <br /> Suaco prmAcToR Aoartess CTT ISrATIJZ P <br /> UCETS_ C-57 _C S1 ii D-M _Other NUAIRM 377923 ExpipAnON DATE 7/31 /17 <br /> GEOGRAPHICAL INco RV.A7IDN: Coordinates X Y Township` Range Section_ <br /> iIxTrNCEDUsE YComestirJPrivale .3 IrrigaGoNAgricuHural C Induslriat :_WaterOua>ityMolitoring J Soil SemP,intylCnataderMCan <br /> -Public Water Systm <br /> 1140Wem"moaner. er em nm <br /> TYPE OF WORK _New Well L RerlaaemerritNell i-WPJ1AheraflonfModifiration 011ter <br /> i ortnrsgS -GectedTniral vor GOAn� <br /> :-�hlomlaring Wells) T o€wzi:s r.SO Borings) I <br /> Oul-OfS"ce Well r Out-Of-Service Well Renewal _C7oss-Cannedion Repair <br /> C New Pum t.Pu <br /> R ammenL iPum Re ar RaseWellto <br /> WeLL CONSTA'jc:MoN ,iJy/u.+-an.. /�-✓�r�^-' <br /> 'Drilling Method _Mud Rotary Air Rotary _Auger = CaNeTool :Push Point Olher <br /> Proposed Well Depth ft Excaw ion in diameter Open Bottom C Gravel PacidGravel Size in diameter <br /> Conrado:Casing in diameter I CanduNarCas¢ig Depth ft <br /> Well Casing Diameter_in Th:dureWlSaupeIASTTA SQted --Steel _1 Plastic C Stainless Steel -011her <br /> Grout Seal Depth It J Neal Cemen 1(94 7b bagrr10gaf wate-r) :i Sano Cement saCP rrbd7 gat water <br /> ;1 Benlanile(20%sdids) _Other <br /> Grout Placement Method ::Pumped Free Fall other Retardant I Accelerator(name) <br /> PEbssTAL Installed By 3 Driller Pump Contractor _ Other <br /> Concrete Pedestal_Dimensions:Vdiah R Length ftTA-k in Christy Box U Stove Pipe <br /> i <br /> PO AP Svomersfhlei3 Turbine Other KP Pump Set - ft Srsnding Watertelel <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, STAT= LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LJCENSE IS <br /> CURRENT AND ACTIVE VATH THE CAUFQRNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPIJANCE WITH ALL <br /> WO OMPEt�A noN LA <br /> M! UM 24 A NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> Tins Corporate Secretesro"Ids <br /> ' ECIEf <br /> i <br /> i SEP 662016 <br /> I I I <br /> NVIROM,4ENTAL HEgL7N <br /> RERUT/SEROCES <br /> � I <br /> I <br /> I t pq y <br /> FC <br /> I I ' R FED <br /> I e V7 414Y <br /> I <br /> DE . ARTMEN7 Lysrj. Td LY <br /> e <br /> Applicalian Accepted Date Area r-rrtployee IMAE�(o <br /> Grout irispeaban BY Date 3 SPE IAL Well Permit <br /> Pump Inspection ByU44 L <br /> j"W 4^'+n i2Date( yz1(� 7 WAIveR Received <br /> Sol Borrip Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Chee)cW Amount Date Ps ! Invoice R Well ID9 <br /> Cod s info Cash Remitted <br /> Sarvlce Reaeouest# <br /> 57D d, 9 7 lP C9=13 I F00 3 <br /> Er0 a3-0G � W£LL 1Pd7A DER:IIr <br /> Received Tine Sep, 6, 2016 4: 12PM Ni o. 1169 � � <br />