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MAY-19-2017 14:59 FROM: TO:4640139 P.2/3 <br /> WELL/PUMP PERMIT <br /> .SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH(DEPARTMENT 1866 EAST HAZELTON AVONUI1-STOCKTON CA 80206-(208)46B•3420 <br /> NON-REFUNDABLE PERMIT CALL(209)963.7697 POR INBPECTIOWB EXPIRES 1 YEAR PROM DATE ISSUED <br /> JO5ADDR050 12000 E MONCURE RD QTY/zIP RIPON, 9x366 <br /> CROaaSTRf;RT 3 MOHLER RD APN� / - IvP4RCELSIZG -1--kLANDUse APPUCA71ONa <br /> OWNER NAME ELEANOR AUFDERMAUR PHONN 599.6606 <br /> OWNER ADDRESS 120QG E MQNQURE RD CITY/BTATO/YIP RIPON&A_Q5M� ........... <br /> CONTRACTOR N& 5 IRRIGATION,/� �INC PRONo 209-39 -3456 <br /> CONTRACTOR ADDR03�i.�,H.�TJ'....MAI N_.�TF3EE.1 CITY/STATCIZIP RIPPQN CA 95366 <br /> SUBCONTRACTOR PHONH <br /> SUBCONTRACTOR ADDRetia CITYfSTATCIZIP <br /> LICENSE i I C•57 I C-at 1 D-00 KOIhaI' C 10 NUMBER 662732 CAPIKATION DATD 0113-1L1- <br /> 0E0GRAPHI4AL INrORMATION: Coardlnatals X Y Township. Range 'Section <br /> INTENDEo U9e 0omealCiPnvale I Imosllon/kricunurRl i1 Industrial I I WRtar QiiRlify Mnnilnrin0 'I Snil SnmpllnplC,hnrnaArlYAlIon <br /> Pubjlc Weler$v6tem _- <br /> _. <br /> NII(oront imm WnAr: -----'----"'—WelCr9Vciom NOW— ""--"' '-"� =WU N6riw 0i Ph0ho NUM <br /> , <br /> I <br /> Ty►r.OF WORN New Well Replacement Well i l Well Attaretlon/Modlfiration I I Other <br /> Monitonnp Welis)_,,,y,_-Sof wells t1 Soll Sorinp(6) cal oaa�0� 11 GeolvGmical rot oonnaa <br /> 0tlt-of-SerVlra WAIL i'1 0III•Of-service Wail Ranewal CroU^Canneofion Repair <br /> New Pum Pump Replacement I I Pump Repair I I Rnise Wnll Crinin <br /> WELLQ9NA7RV�ON <br /> Drilling Mothod Mud Rotary Air Rotary Augur I Cable Tool I Puah Polnl I Other <br /> Proposed Well Depth It ExcavatIoR In diameter 1 Open Bottom i Gravgl Prick/Gravel Size In diameter <br /> . COndIICt0r Casing In dlometer / Conductor CeEMU Depth n <br /> Wall Caning Diameter—_in ThlCkne6a/Gau0e/ASTM SChetl .1 Steel I.i Ploallc rl SlalntOaA 91eal r,01hur <br /> Grout Sool Depth R 1.1 Naol Comonl(04/b baU151 G Gal wafer) 1 SAnd Cement sack mlxR pal water <br /> Dentonlle(20%aalida) I I Other <br /> Grout Placement Method "I Pumped �'I Free Fell I Other '.I Retardant/Accelerator(name) <br /> QEQEBIaL Instollad By i Drillor I..Pump Contractor Othor <br /> Cuuuete PedealAl Diumnaiuua.Width n Lmlylll II I11iG IIl Chrlaty DOM I dtovo PIP0 <br /> P Submeroulel Turbine I Other hip Pump Sal n Slandln Weler Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL UP DONE IN ACCORDANCE WITH BAN <br /> COUNTY DINANCE6, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IH <br /> URRE ANA AC WITH THE ALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> ORKFinOMPIC TION L B. <br /> I U 4 U A A CE REQUIRED F1O�R�IANSP�EACTTI�ONSf-PLEASE CALL(209 963-707 <br /> SIaNeD TITLE r"�fCf`r KLr�i�vi OATC <br /> N <br /> _$ <br /> OL <br /> �-an <br /> ' Vs F'- <br /> PP`(!� N — — — — JGb�— _ _ — OMAENTALHEALTH <br /> E Y <br /> JW <br /> JO'a so'�PTN`'- Q P.A R T M H N T U E N L Y <br /> to <br /> EH DFP (,t✓wJ <br /> AppliCAllon A4CeP10d ray Dow Afaa E'nployee IDo <br /> Grout Inspection By Oato SPECIAL WOII P--Ilt <br /> Pump Inspection By E��'`'Yy f Data /Ci G WA)vER RoCOIVOtl <br /> Soil Boring Inspection ey Date Conbtruclod Wall Depth rt <br /> COMMENTS <br /> pil f3 Roaolvod Choykrl Amount Porm V <br /> Cada* Info B CAsh Parriltled Dala Service Re ueet V Invoke 0 Well IDN <br /> All I <br /> Received Timem May, 19. 2017 3 : 29PM No. 1541 US70 WELL UMP PERMIT <br />