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MAY-1'-2017 11: 19 FROM: TO:4640132 P.2-4 <br /> WELUPUMP PERMIT <br /> SAN JOAOUIN COUNTY EWPONMONTAL HEALTH DEPARTNIANT 1860 EASY HAZeLTON AVE Ni-STOCKTON CA 06206-12i 460.3420 <br /> NON-RPFUNDABL6 PERMIT CALL 209 963-71187 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE 19SuE0 <br /> m <br /> Joe AODste33 11211 E. SOUTHLAND RD CITY/ZIP MANTECA 95336 � <br /> CROBBSTREET PRE-SCOTT RDAPN O`SC� 'IZ— PARCEL SIZE LAND Us E APPLICATION III <br /> OWNERNAAt IS DELORES KIM LF <br /> I/ M, L � &. a i)� PRONE 2 9-4345 <br /> OwNanAopAGea 11211 E SOUTHLANO RD CITNISTATEMP MANTECA, CA. 95336 <br /> CONTRACTOR N &$ IRRIGATION, INC PHONa 209.599.3466. <br /> CONTRACTOR AOOREU 215 W MAIN STREET CITYISTATelZiP RIPON CTA A..5,18B <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR AOOpau �/ CITYISrAT1i <br /> LiQtNak .1 C'57 j C-01 0.00 XOther____Q 1_Q�- NUi (3g 2732 EXPIRATION DAT9 01/31/19 <br /> OBOORAPHICAL INFORMATION: COOndlnetes X Y Township_ R■nge 5.4dan_ <br /> INT11,NDRD i 00mee11C/PAVe11e _1 ImgatiONAgncultulal D lWuvUlpl LlWeler QuelltV Monitoring I7 Soil SampllnyCheroatoltzatlen <br /> Publk Wei&Symom <br /> d dil erent llum Ow c A e 1,Vb1crin NaWone ei TPII <br /> TTr5 Qi WORK _ Naw WOII - Replacement Wall ❑Wall AltorutlorVModIIICAIIon n Other <br /> Monitoring Woll(s) 0 of sella I I$oll Borings) e m fnangr 1_I Geoternnlcal a of Coorvo <br /> _ Out-CfServiee Well G Out,01.6erviea Well Renewal ❑ Crow-Connoctlon Repair <br /> New Pump X Pump Re Isoemant `7 Pump Re air n R6100 Wall Coln <br /> WRLL CONBTRUCTION <br /> Dr!11Ing Method Mud Rotary -Air Rotary Augar i I Cattle Tool n Push Point r Other <br /> Proposed Wall Depth It Exravaeon in diameter _i Open Bottom A Gravel Pack/Greval Slza In dlameter <br /> _ Conductor Casing in dlAmeter I ConduClor Casing Depth A <br /> Well Casing Dlemeter_m ThlcxnesslGnugerA61'M 64160 i Steel a PtBsllc 11 Simnloaa 3tnol ill ONer <br /> Grout Sssl Depth h r!Now Cement(04 ID D6216.10 gd1 water) I i Sand C■menl awk mixt!gal water <br /> - Benlonite(201 r lids) rI Other <br /> Grout Placement Method I Pumped C Froa Fell ❑Other I Relardant I Ar4eleretor(nemo) <br /> PeonsrAL Installed By Caller L Pump Contractor Other <br /> Concrots Podeetal Dlmenslons:Width n Lan h tt Tnic In - Chr s ltox Btove Pipe <br /> P-i XSubrinerillbei Turbine I'.Other HP Pump Seln 6tanding Water Leval <br /> REBY CERTIFY THAT I HAVE PREPARIED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOA N COUNTY RDINANCES, 67ATC LAWS, AND RULES AND REGULATIONS. I AL60 CERTIPY THAT MY R@QUIRL'D LICENSE IS <br /> CURRE T AND VE WITH T CALIPORNIA C NTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKE COMP N AT10�RTADAM <br /> N1m m HTICS REQUIRED FOR INSPE�CTIO�N�S-PLEASE CALL(zos)e53-7887 <br /> 31aNt nrLe N _f DATti �' <br /> N <br /> Is I <br /> 1 44M <br /> REOE�vP1p <br /> OWN4 Fir Poll <br /> �EINt pHEpp T1At,. <br /> 1� )o <br /> MEN7 U E ONLY � ��AppllCatlOn ACCepted Dyte - Area_jT"-�'-- Employee ID9�Y!Jt'OY�lfw� <br /> Grout inspection By Data OII Pormlt <br /> Pump Inspection By t '." Date L' C WAIVER Rocalvod <br /> Boil Boring Inspw-By Dato�— - -�_,,�,7 Constructed Well Depth A <br /> COMMENTS �L�S'Vl;t //)5/1 <br /> _.� <br /> PE sc Recolvod hack Amount Cato erm Invoice to Wall IDs <br /> Cods. Into IS Cneh Remittee Ii RA "'Ala <br /> -f t "j-, cG 773 "1 00 W <br /> Received Ti,mel May, 1. 2017 11 ,48AM No, 1358 0g)_9 WELLnrIu°°ERMm <br />