Laserfiche WebLink
#7960 WELL/PUMP PERMIT <br /> SAN JOcQM COUNTv DsrA T 600&Main Street• TON CA 95202-(2n)468,3424 <br /> NON•REFUNDAELE PFmAm 1 CALL 209 953-7697roR INSPECTIONS Ii,X1EeIREB I YEAR FROMDATE ISSUED <br /> I <br /> JOB AVPRM 6912 Delta Avenue (,-=rLw Tracy 95304 <br /> CROSS S VJMT MacArthur t Am 213-020-08 PARCEt.sa.RW Gl0 IANDVSEAPtn.tCAnoxa <br /> OWNRENAME Ernie Costamagna Puopm 559-269-2032 <br /> OwmatADDttass P.D. Box 817 CT7r19rwrvzir „San Joaquin, CA 9366 <br /> I <br /> CONTRACTOR __Delta 1?Hru2 Pao-1U-4(L-2U5_ <br /> - %r <br /> COMMACM3tADDRcss 646 SA California Street Ct7Y/STATF/7.IP Stockton, CA 952¢3 <br /> SUECONMCtnn I PRONE <br /> SIUBCON7RACTOR ADDRESS 1 CrrVISTAT MIF <br /> 1xv4sE 00,57 )QC-6! 13 D-09 pother Nuamrn 724778 ERP®ATYONDA-= 8/08 <br /> CKO&WAMCALINFORMAMON; Ctwrdlnetes X X Townahlp RangE Section <br /> I TWDLD Usti XXDamestiWPrivate 1 O lnigation/Agticultatal 0Industrial O Water Quality Monttaaing ❑Sail Sanpling/Charaehsiation <br /> 17 Public Water System <br /> If affarm[rem Ovrorr. rrc syo w 14ere — <br /> TYPR OP WORN 13New Welt ca Replace=m Well ❑Well Alteratton/ModiBcation a Other <br /> ❑Monitoring Well(s) N ofwells f:l Soil Boring(s) <br /> r of b.,hW !]G;Eeaeehnical 1°f 6erings <br /> E3 Out-of-smica Well 0 ClotrOf-Servicc Well Renewal 0 Gross-Connection Repair <br /> XXNew PuM d Nm2 Rcplacenteat 0 Pa <br /> WELL Comsrit Ic ioN i <br /> Drilling Method ❑Mud Rotary d Air Rotary 0 Auger D Cable Tout 0 push Point ©othar <br /> Propased Well Depth to FXcavation_ to diameter D Open Batmm O Gravel Pack I Gravel Ske ius disundu <br /> O Conductor Casing in diameter 1 Conductor Casing Depth R <br /> WEII c4wvg Diameter—in j ThicknesslGangdASTM Schell Q Steel O Plastic IJ Stainless Steal 1300M � <br /> Grout Beal Depth a ft O Neat Camcat(5416 bog/5-10gaf wafer) Q Saud Ccrnent aackmfx 17 gal water <br /> O Beatonitc(2c%solids) ❑Manufacturer Spec%solids_% Name 17 Specs on File 0 Spocs Submitted <br /> Groat Placement Method O Pumped O Free Fall 0 Caber O REurdaut I Accelc=r(name) <br /> PIMESTAL Lnatalled By 0 Driller ❑Pump Contractor Q Gabor <br /> 0 Concrete Pedestal Diaaenaioua:Width: it Lcnglh _RTkidt in 0 Christy Dox 0 Stowe Pipe <br /> lam ubmersibk O Turhine Other ^1P 3 Pump Su 1 08 It Staoding Water Leml <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 Wri71 THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WrfH ALL <br /> WORKERS COMPENSATION LAWS <br /> i M M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SYGNEn r 1"= CEO DATE 01/08 <br /> I <br /> 1 <br /> i1! <br /> f ` <br /> T <br /> X1 IT <br /> 1 � <br /> M <br /> D YTMENTD USE; ONLY 9 <br /> Application Aeceptod B., hate Area Employee JDp�! <br /> Grout InWectiae By sere ❑ SPECIAL Well Permit <br /> Pump Inspcodw By Date / ❑ WAIVER Received <br /> Constructed Woll De !t <br /> COMMENTS_ <br /> 1 <br /> PE SC Received -W Alvonat Date Lnrake# WCHM# <br /> Codes Into B emitted Service nest# <br /> �— <br />