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81WIN Wd[O:b 8106 '86'AON ;Wli P;AI;3;d <br />WELLIPUMP PERMIT <br />SAN JoARIPN CouNTY ENNRarnlewrALHEALTH DE PAIT MENT 1868 EASTHAMTON AVENUE-STOCKTON CA 95205 -109)46&,1420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR [NSPECTIONS EXPIRES 4 YEAR FROM DATeIssum <br />ADDRESS <br />" <br />ss STR>:Er APN <br />IEK UMAE , ' <br />PER Amopzs5 <br />TRACT Purviance Drillers, Inc <br />TPA=R AaoxEss PO -BOX 64 <br />CmoaP <br />Use APPLICATIDNt <br />PMNE 209-887-3554 <br />CInrSTtIrd,.Lin4en, CA 95236 <br />PHane <br />ISVBCONTRADTORAixmEss CITY]STA-Mol, <br />LicEmse �,{ CS7 D G61 G D 09 O Other Nustllst 3 7 ! 9 2 3 E1139 -nOU DATE 7 / 31 % 19 <br />n....a.�.,.'Arm.. .= - Genera! MineralM-Aiinnn BR&eda (4391) E Dib rpracc tompropane (4392) - Arsert[C (4393) <br />NroaaroU++E DamesticMr�te G InigaliionfA9dcullt al G Industdal G WaterQuality MOnifOnng D Sal S2T1Prn91Characteroali <br />Lt Public Water System <br />ad(I'elenlfroatQ+mec lvaer s»tm Nam Gbyea Narr or PhoAa Nwnta <br />TyPEOFWORK (3 Nm7VVPfl C Replacement Well n WeliAlteraHan/MOdficaSan J Via <br />E! Motlitoln19'NetKs) F, of wills G Sml Borings) <br />Cofboriocs C GCOICUQT4Cd1 °rte <br />C Out-0fService. thea C Out-MSenrice Well Renewal :1 Crass-C0tmec1kM Repalr <br />C1 Neve Puma f Pump Replacement C Pump Repair D Raise Well Casing T <br />Dr111m9tAethod D Mud Rotary t- Air Rotary D Auger 3 C-bleTaal 7 Push Point n Other <br />'Proposed Well Depth it Eua%alian in 6arneter = Open eot(CM C Gravel P2ddGravel SaP_ In diameter <br />O ConductorCasng in dianeW f CondutanrCasing Depth ft <br />Well Casing Oiameler_ in TtadmesslGauge/ASTM Schell = Steel O Plastic O Slainle_ss Steel ---]Other_ <br />Grout Seal Depth it 0Neat Cement(94(bnaa54Ogar t1fated :ISand Cement sackrnicf7lialurdler <br />CHernanile(20%solids) 3Other <br />Grout Placement Methad U Pumped D Free Fall 7 Other C RetardattlAccelerator Came) <br />PEDESTAL fasialled By D Wier 7 Pump Contractor 13 Other <br />e Concrete Pedestal CDlmernslaar. Vl4dth K Length ftTludc in 7 GhresfyBDx J Sb�Ve Plpe <br />PUMP • Sututseisib'eD Tuitine :1 Other HP PUMP Set ft Standing Water l eue7 R <br />1 HEREBY CERnFY THAT 1 HAVE PREPARED 1145 APPLICATION AND-'Li1AT THE WORK WILL SE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STAT LAWS. Arm RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MYREQUIREDUGBLSE IS <br />CURRENT AND ACZVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WfrH ALL <br />OTICE REQUIRED FOR IMSPEC7lONS - PLEASE CALL 1209) ,5 7657 <br />:k corporate SecretarBATE / <br />m <br />w <br />v o <br />z <br />vi °Ro c,,N9 X018 <br />Ty�FAq T 4 <br />NT <br />EP RTMENT SSEn]Txt�Y <br />ApPlirt6onAccepted By Cale 2-p t" Area <br />FsnPlayeelO#� <br />Gfoutlnspection BY <br />Elate D PEC <br />wL Well Permit <br />Pump Inspeckon IBY (1rY�, Qs�w`�'•tdLllrslate D WAvER Received <br />SW Boring lrLsP—Han BY Care Constructed Well Depth R <br />E}!p0;-ca mim <br />Z -d <br />( -,� rSZr3l 3S5 <br />VZGEZ9960Z <br />tn�r�:s� Pour <br />out SJajj!.IQ aouoiAind d0£ b0 9� 97 AON <br />r'�T�llli►�'�6i�'I�It��iL'lil��7- <br />E}!p0;-ca mim <br />Z -d <br />( -,� rSZr3l 3S5 <br />VZGEZ9960Z <br />tn�r�:s� Pour <br />out SJajj!.IQ aouoiAind d0£ b0 9� 97 AON <br />