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09WON N61 :6 L106 -9Z-ung awil paAI ;3;� <br /> VVELUPUInP PERMIT <br /> SANJCAQUIN COUNTY ENYQtoNMENTAL HEALTH DEPARTMENT 1866 EASTHAZELTON AVENUE-STOCKTON CA 95205-(2D9)JfiBJ42o <br /> NON-REFUNDABLE PERMIT CALL(20S)953-7697 Fop JNSPECTIONS EXPIRES 1 YEAR FROM DATE ISsuED <br /> JOBAOoRess 151 W Armstrong Rd - Lodi Ca 95242 <br /> /� <br /> CROSS STREET Davis Rd APN ZZ o f O PARCELSIZE U• LAND USE APPLICARON 4 o <br /> a <br /> (OWNER NAME Arlene Lawry p,,.,.209-36 9-3198 <br /> OWNER ADDRESS 1515 W Armstrong Rd CMiSTATEalP <br /> CONTRACTOR Purviance Drillers, Inc. PHONE 209-8877-3554 <br /> CONTRACTOR ADDRESS P. 0• 13oX 64 CITYIS'rATSrZM Linden, Ck 2c)523 <br /> SUBCONTRACTOR _ PHOUE <br /> SUBCONTRACTOR ADDness CITYISTATFlhP <br /> [UCEKSE _C-57 _C-61 ,�0a9 Other NUs1BER 377923_ 7/31 /17 <br /> EXPIRATION DATE <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> 7,vrtiDEDUsE Q0omeSGrlPrivate r:Inigation/Agdcuttutal L:Industrial =WaterCualityLAor0oring 'Srn7Sampling/Chardclerizalion <br /> :Public Water System <br /> IfdPremal from OYmer. & em arae ane eec ar one o <br /> DI MOFWCRK NetvWell _RBPIRCZMentWel :,We$AlteratioNModificaiion Other <br /> MonitoringTAleN(s) soivrells I So313adng(s) "e100°n9s r-Geotechnical fiotoadnr/s <br /> Out-or-Sery co Wen - <br /> Out-01-Service Well Rene vaf -Gass-Connection Repair <br /> NewPump Pump Repl2cernpni O Pump Re air =Raise Wel Casin <br /> ii <br /> VYELL CONSTRUCDON <br /> Drilling Method Mud Rolary Air Rotary . Auger _Cable Tact _push Point Olher <br /> Proposed Well Depth ff Excavation in diameter 'Open Bottom _Gravel Pack/Gravel SIZe in dameterl <br /> ConduclorCesclg In dlameter I Conductor Casing Depth ft <br /> Well Casing Diameter,_in Thickne4WGaugPJASTM SChed i_Steel =plastic =Stainless Steel =Other <br /> Grout Seal Depth 11 i'Neat Cement(94/bbad5-TOgatetater) _Sand Cement -sack mixfgal water <br /> -Benlonile(20°5 sdids) Other <br /> Grout Placement Method 7 Pumped C Free Fall =.Other Z Retardant I Accelerator(name) <br /> PaDESTAL Installed By _Driller .Pump Contractor Other <br /> u ConcretePedestal:-Dimensions:WAth it Length RTtnck in _Christy Box _Stove Pipe <br /> Pu11P A Submersibteu TurNne ::Other HP Pump Set h Standing Water Level it <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,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I Ahl IN COMPLIANCE WITH ALL <br /> bL'O WSBf1�COIIMIP <br /> VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209) 53-7697 <br /> SIGNS - TrrtE Corporate Secret � <br /> t Y <br /> PAYMENT 4 lr 'VE® <br /> RECEIVED I <br /> N z6 2017 <br /> JUN 262 <br /> SikS JOAQutN co , M-rSLR�C7TH <br /> FWVRIONMENT <br /> HSTH DEPART I <br /> D ARTMENT SE —N��L—Y 'C r <br /> Application Amepled BY Date t� 1 Area fa//G��rEmployee ID; (D <br /> Grout Inspeclicrt By M-4Date SPECIAL UVtal(P9Tmlt <br /> Pump InsZledion By J Dale ❑ WAIVER Received <br /> Soil Boring rnspeciion By Date Constructed Well Depth n <br /> COMMENTS <br /> PE SC Received Checw Amount Permit/ <br /> CD Into B Cash emlted Date Service Re uestm lnvoice9 Wel3ID# <br /> 17 01.1 N wpooI <br /> anmlz <br /> YletLfPUua PtTTrrT <br /> Z-d tL9£L8860Z out sialp(]eoueuund dZZ Z0 L L 9Z un(' <br />