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Nov 04 00 10:40p _ p 2 <br /> IOCA-�/d�l <br /> WELUPUMP PERMIT <br /> Sari.FoA7uM Couwy ExymoNm ENTAL Tet D5PARTmFJ4T1668 FA � <br /> n kLTON Avr-NuE_SToacrorr CA"205-(209)46t1-342D <br /> NON-REAINDAaLE PERmn I CALL 209 953-7697 FOR INSPECTIONS EXPIRES i YEAR FRom DATE ISSUED <br /> JcwAwimss1 3600 F. Brjandt Rd_ �TYmr. Lockeford CID <br /> 5 sTr�r Jack Tone APN 0 5 3—0 3 0=fl 1 PARtgSTM Latro uss APPuaT o>a x $ <br /> CWWM NAME Ray Co l l ilne P fpNE <br /> OwPfmAnoRrmss 1 257 Jenevin AveCRy A Z,'San Rruno CA 94066 <br /> �w7RA=T0,.-4 Purviance; Drillers, Inc. 209-887-3554 <br /> cAN aACTnRaooa�s P. 0. �eicx 6 4 i nae o f <br /> CrVIS5rATCQP <br /> SUBCc TPACroR P1tGHE <br /> SUECCHTRAGTDR AmCR= Crrv/STATEIZ]P <br /> uC:0nse X osi D C-61 ❑0-C9 ❑ower N._177923 DA. 7/31 /1 5 <br /> Gr=0GRAPf19CALlworufpttdc CooriGnetrs X Y Township_ Range SccbonV <br /> INT>=xnmuse G Oomesy r%lre a latabeivagrimnura! C rntusiro! ❑W"rOuafdyM:mtagng G Soil Samp!ing!Chare ae.tmliun <br /> 0 Pubic Weter bystern i I <br /> 'rCAttrtrR Smv Orr <br /> TYPE OP Wow IrNew Weft G ReWaernent Wel G WeUAnefaU moMicatt0n G Other <br /> G A7anitoring VJeli(s) to of vrels GSaileadvs} reoaa.ss ! DGeo'edrnirai Fm emngs <br /> O outLif-s rvic a Wen Out-0I�Servioe Wdl Renevral O Crow;Connection Fepair <br /> New Pu 0 lacenwnt Purnp it G Rarse Weli CasLi <br /> t196T1 LbTl9TRI2 Cm y <br /> balling Method •Nh,d ITatary O Air RzWry 0 Auger n Cable Tool o Push Polnl O O�har <br /> Proposed Well Depth.l11 ft Exce-atwn/4 ray in dameter it open BatSwn C Gravel Paworavei S¢a in diameter <br /> O Corr.?ursor Cesllg in dituneter ! ConduMr Casirtg Depth it <br /> I Well Casing DLwr±etert0* TMd,,sswGaupe/AS-rm SMted 1,,r t Steel a pb-Ift D Stainless Steel O Other <br /> Grout Seal Depth 2,L0 ft ❑NeatCernent <br /> (9slb6agf�fOgalNatar) 5 SardCenem /o.S <br /> sock merngal waeer� <br /> r 0 Bentvnae(20%soWs) D Other <br /> Grout Placement Method W Purnped U Free Fall 0 Other D Ret artt IA=Wemwr(rame) <br /> PED=11L Irtufalled By Driller j Pump Contrador 0 01her <br /> O Concrete Pedusbl r)Oimersslom%Vidth ft Lon gth o Ttzdt n - Christy Bos 0 Steve Pipe <br /> IPga G Submermbie:7 TurWne O Olher HP Pump Se; R St2ndmg VJarerLwal ft <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WrTH SAN <br /> JOACtULH COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT My REOUNJED LICENSE LS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COhUIL1ANCE WITH ALL <br /> WORKERS 00b PEiSATIO <br /> �UM VANCE NONCE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)951-7697 <br /> sl�r��i1 'amu TME Corporate SecretaFAK 9/22/14 <br /> � I <br /> I I t <br /> ' f <br /> i I I I <br /> Lt J <br /> I <br /> I <br /> I o I <br /> I i <br /> I I <br /> - I I <br /> I I <br /> i <br /> 1 <br /> I <br /> DEPARTMENT USE ONLY <br /> Applieatton Accepted By Date Amo Emp;opoe 10S <br /> GmW Inspedlan By Date D SPECtAL Well Permit <br /> Purvp lnsgeddn By Dale D WWER Rece iced <br /> Soil Bart v inspection By Date ..t Well Depth ft <br /> PE I SC Rocelved Chacw A-- Date Pew Invoice i Well IDS <br /> Codes Info Cash Remltted Service Requestb <br /> i <br /> i <br /> Vit-L fp LW PERwrr <br /> 4=tZ <br /> Received Time Apr, 7. 2015 3 : 06PM No. 8478 <br />