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980 '°N Md c ( l0Z ung ;WIl p;AI ;); <br /> ffffLUPLJMP PERMIT <br /> ` <br /> SAN JoAwNComwFimROWAEarALHEAL-MDOPAKM K7 1868EASTHA2B_7MVAWMUE-STOGWMtCASS2415-(269)4683420 <br /> UON-REFUNDAEILe PaamT CALL 09 953-7697 FOR INSPEC MONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> `Jaa Aorl <br /> 3792 N Beecher Rd Stockton 95215 <br /> n <br /> canss5�»Er Fairchild Rd Ap ' PARCEL 5; tlroaLSEADFLGaTICU <br /> r. <br /> OVTrtEiz slu>F <br /> Richard Reitnauer FHo,L209-931 -1 337 <br /> Orvrr--=zAoaREss 3792:: U Beecher Rd c,,jS;ATEIZIp Stockton CA 95211; <br /> ,CC6nWAC7CR Purviauce grillers, Inc Peat,= 209-887-3554 <br /> eco ncroRaoaWEss PO bog 64 c„yjsrA,vz,PLintie n , CA 95236 1 <br /> SUBCONTRACTOR Peo}F. <br /> SUsac,rrRAcMR ADDRESS <br /> CnY1 <br /> Lj rise r 57 u csl t o oms NULMM 3 7 7 9 3 EXPMAWN DATc 7/31119 <br /> DomEsnCjM¢LSAwpLa:=0 Gener3i A,ImeraUCC&fotm a2Cteria(4391)C mromach{otopmpane(9392):Arsenic(4393) <br /> INTatom USE Q 0oinumUc7rivele G IrngaGonrATindWral C Industrial G Waffir QUaIiity FAuMforurg 0 Soil ZampEngtChamcledrafan <br /> 0 PuSI'swater syslem <br /> ad7Quen h.-n rem c :vaersyn�n Norte CWCW 19'erC°r Ph=N.,1v <br /> TYPE-OFW014K LT Nev,Weg C Reptarrnrent Well G We]Alle=WrVMod1f=fion -2 016e' <br /> n(dmrilanpWa7(sl mOfr�s GSoOBaing[s) °0fevrt°`s CGeafechnical <br /> tafDn <br /> I-,out-ofSen,ice Well C OW-O'.sen,ica Well Renewal D CmssCeTmecuon Reoalr <br /> 0 NevrPuma Ilp Purnp Re Lacem" %Pump Re=lf :1 Raisa"W1Cas-mg <br /> kk WELL COMSTRUCTION <br /> FPnWng Method O Mud Rolm-j C Air FZanry 0 AUBer -J Canle'Tool 7 Push Pnint I Other <br /> ropasedlveil Depth—ft Exeavalion inSsmeler _Opeaaodarn E GcavelParJJGrauelS!7 indmrreler <br /> G CrnducderCasing in diameter I CondurinrCasing DE�lh fl <br /> Weill Casing Diameter,in Th-tknoSSiGaugalASi1N Schad _Steel D Peds ?SfairlleSS Steel 7 Other <br /> Grout Seat Deplhtin 0 Neat Cement(94lbbarF-1n galwater1 7 Sind Cement sarirfirRgz1 vats) <br /> C Senlmite(2d:i.sa6ds) 7 QNer <br /> Grout plamoantMethod D Pumped 0 Fm-a Faft 7 Other C Retardantf A•rel crl—) <br /> A.AL Installed 6y Q DrZer -3 P=p ConrzaUar 0 Other <br /> C ConcretepedastalCDimeristerts-WdRj ft L=gth ItTttick in -1 Chrfs;WBas J Shove Pipe <br /> PUmp IkSubmEmVeOTusbim 7 olher HP Pump S ft Slandmg lflfateT Levu fl <br /> I HERc�Y CERTIFY THAT 1 HAVE PREPARED THS APPLICAT10t3 AND THAT THE VfMK WILL 6E DONE IM ACCORDANCE WITH SARI <br /> JOAQUIN COUNTY ORDINANCES,SfATc LAWS, AND RULES AND REGtlLAT1oNS. I ALSO CERTIFY THAT WT REQUIRED LICENSE IS <br /> CURRENT,AND ACTIVE IATr,4 TIE CALIFORNIA CONTRACMRS STATE LICENSE HOARD AND THAT t ALG IN CC),MPLIANCE QWr)-f ALL <br /> S"JO MPENSA O 1 <br /> MIN M q C 11MCE N07)CE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SI�n T,,�orperate Secretary, <br /> ; 11111 1 I f <br /> Ilfll { € I ! I I I ! ! III f <br /> li ) Ili 111 1 I II II illi �jy�, <br /> I i I II I III �T <br /> CE/vzb <br /> I1 il � i � I ! itI I I 1 11 1 ! 1 132OlS <br /> I I I l I l l I i t I I 1 111 1 A) <br /> ! I I 1 I MEjNV Ot <br /> rA <br /> 111 I Il I I1 C <br /> ! ! I I I € I I I 1 1 I I I �ZMENT <br /> I II I I ! I ! Il l IIE I ! <br /> I I I � � II Ilj IIlI I li <br /> ! <br /> EP RTUENT SE NLY <br /> AppG�Eian AaxPterj By to Area Employee <br /> G=t Inspection By Date _3 PECIAL UYe(l Permit <br /> PrMrp IrtSPecEnn eY L Dae ) T7RJ 0 WAIvER Received <br /> Solt Baring Inspect an BY Date constructed Wall Depth R <br /> COMMENTS <br /> PE SC Receivad CherJd'J Amount FeTmiU [mroirr:, Well lW <br /> Ca __Info. -- — . _--- -.-,! ---. Remitted O�e uestN <br /> I ) <br /> I I € <br /> t7 tZGU9860Z G �/� OUl S-lelllaQ e0Ue1nand db0 E0 6 L co unf <br />