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l6Sl "N AdSO:ti L106 '6Z 'APA awij paAiaD;� <br /> • VVELL/PLIMP PERMIT 3 <br /> SAN J OAQUIN COUNTY ENMONMENTAL HEALTH DEPARTMENT 1ESH EAST HAZELTON AVFNDE-STOCKTON CA952B9-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209)9153-7697 FOR INSPECnONS EXPIRES 9 YEAR FROM DATE ISSUED <br /> JoaAmopms 2700 N Fine Rd C,TTMp Linden , CA 95236 m <br /> CRDSs STREET Fine R d APN 09305001 PARCEL S., 5 9 LAND USE APPLICATION p a <br /> OWNER NAME VA Vineyards II h*ft 9P Lr PHONE 2U q_4193_ iRss <br /> OWNER AooREs$15 N FP - Linden CA <br /> Cm/STATFIZ <br /> ��o�TRA�aR Purvi-ance Drillers, Inc. PHONE 209-887-3554 <br /> 'CONTRACTOR ACOR as P. O. R o x 64 an/s,ATEr4P L;nd e n, CD, 9523 <br /> iSUBCONTItAcTOR <br /> SUBCONTRACTOR PHONE <br /> ADDRESS CrrY)STATFIZIP <br /> LICR.SE X C57 _C-61 i:D-09 _Olher NUMBER 377923 F p..TJON DATE 7/31 /17 <br /> GEOGRAPHICAL INFOANATON: Coordinates Y T--ship_ Range Section- <br /> FL-11-END- <br /> ection_ <br /> I11 END-USE _DorneSIWPrivate )%InigationfAgdcullvral 1.Indusldsl ..-Water Cualitj Monilorino -Soil SamplingJCt>aractrsizalion <br /> I <br /> PublicVfater System <br /> IIfdiHarenl rmm Owner, rrr ys em rn° -la ame or Phara NZdZer <br /> -YFEOFWORK _'NeWWell _ ReplacemenzWell :;Well Allerationfl/,odificaton =Other <br /> I'Aa6toringWell(s) 9-ofvNalls SoilBwing(s) a°re°nws .- Geotechnical °orE°r gs <br /> Out-Of-Service Well -Out-Of-Service Well Renewal -Cross-Connection Pepair <br /> !New Puinp PUMP Replacement E]Pump Repair -Rarse Weir Caste <br /> IWELL CONSTRUCTION <br /> Drilling Method a klvd Rotary AirRotan, Auger _Cabl_Tool _Push Point _ Other <br /> F'roposed Well Depth ft E xcavadon in diameter =Duerr Dotlom = Gra Pa�cJGravei Size n dsrnelerf <br /> Conductor Casing indiameter J ConductcrCasingDepth R <br /> Well Casing Diameter_in Thicntess'GaugeJASTM Srhed Steel a plastic L-SlalnlessStee) D Olher <br /> Grout Seal Depth HC Neal Cement(94 It)beaS-10galtvateh Sand Cement sackmixfTgalNvater <br /> Semonite(2U%solids) ::Other <br /> Grout Placement Method 7.Pumped Free Fall _Other I Retardant)Accelerator(name) <br /> PEDESTAL Installed By _Driller 7.Pump Contractor Other <br /> ::Concrete Pedestal_Dimensions:Width rt Length ItThick in L;Christy Boz _Stove Pipe <br /> i PULiP .:Submersible Turbine -: Cther HP PL=P Set .Standing Water Level it % <br /> I HEREBY CERTIFY THAT 1 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_ 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL/ <br /> WORKERS COMPENSATION LAWS. <br /> fifiINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> 'SIGNED TALE Corporate Secreta,,W 5/29/17 <br /> I I i <br /> ill <br /> I ! I <br /> om <br /> i i I I <br /> It <br /> l <br /> T <br /> I <br /> l �o <br /> it II I I T <br /> l <br /> � 1 I I I I <br /> EP RTMEMT✓ SE ONLV <br /> Application Accepted By ale �J Area�gI Employee ID-- <br /> Grout Inspection By Dale D SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Solt SDrittg inspection By Date Constructed Well Oepth.- tt <br /> COMMENTS <br /> PE SC I Received Check-W Amount Date Permit/ Invoice# We11IDB <br /> Codes Info B Cash Remitted ervir Request <br /> 1410.1p c� r I'00nal! <br /> f _ <br /> 1OnnT :✓a.LMAP PERr.aT <br /> 601 <br /> Z'd t'L5£L9960Z oul saallloa eouelnand d L L:t'O L L 6Z AeN <br />