Laserfiche WebLink
WELL/PUMP PERMIT <br /> SANJOAQVINCOLTTYENWRONMEWALHGLTHDEPAIITMEM 3I4EWEBERAW3-FL•STOCKT0NCA95202 - (209)"8-3120 <br /> NON-REFUNDABLE PERMIT CALL(2,0,91)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR <br /> �FROM <br /> DATE <br /> �ISSUED <br /> JOB ADDRESS w CMILZIIP�� z r <br /> Castle;STREET P r PARCELSrzE (1.14 LANDUSLAMJGTN)NB LS• <br /> O.EN NAME —��. ,wL��S FUME <br /> w ^' YR <br /> OER A...ESS 1-2 Z_ r Aloe 1 1,�yX O _ CRYISTATEMSP <br /> CoM,Ac ftN C /� P"oerr <br /> CoVT ETDRADDRESS N CMISTATEMP <br /> SL'BCONTRALTOtt PNONE <br /> SDBcix M;A V)R ADDRESS_ CMISTATE/ZIP <br /> LICENSE 37 ❑Cbl 0609 ❑Other NI:MBEn E%PIMTIONDATE ?L*5'�-5' <br /> GEOONANDEALDFIRRMATMO : Coordl..W % Y Towoship_ Range_ Section_ <br /> IeRi.WDED USE ❑Domatic/Prfvae, ❑ pnoofAgn I (�I ❑ dustrial ❑Water Qualiry,Menilanng C3 S61 Sampling/CM1arsteAmion <br /> Dbww.gm �of��1 t�a�lrvf x�na)!_ e <br /> R <br /> Tm:OP WORK ❑New Well Replacement Well ❑Well AltentioNModifiation ❑Test Hok Cl Other ` <br /> O Monitonng We I(,)_N of wells ❑Soil Boring(s) a of be.ny ❑Oemechoic.] —a of 1pnnp v l <br /> ❑Well Destruction 0 OutOf-Service Well ❑Out-Of-Service Well Renewal <br /> Elum New PE3 Pum R kccnat Cl Pump Repair C]Co ss-conneeoon R it <br /> WELL CONSTRuW(I�n <br /> Drilling Method ®-L.1ud Binary ❑Air Rosary ❑Auger ❑Coble Taol 13Puzh Pant ❑Other <br /> Proposed Wait Depth 340 R Eac.velion IC di.meta ❑Open Bosom xGnvel Pack/Gravel Sin in diameter <br /> ❑Co-d Dag Indismus / ConduclorCuiog Depth 0 <br /> Well Caring Diametu�,in ThickmsWGuge/ASTM Schell ?D� 0— <br /> wall ❑Sminba Steel ❑Other <br /> Grout Seal Depth 2gW 0 ❑Nat Cemrnt(9//h hog 1540g,,1.11r) �Smd Cement IL9, !r sack MU/7 gal vmer <br /> ❑Bentoniw(20%solids) ❑Maeufecturer Spec%wlids % Name ❑Specson Fik ❑Specs Submitted <br /> Grout Placement Method ❑Pumped ❑Frs Fall ❑Otho ❑Retardant/Acochouts(mmc) <br /> PEDESTAL lanlled By ❑Dnikr ❑Pump mIt <br /> C.MMIOr Other <br /> R!.Co.oete PMestel DI.do : Width Leogth R Thick ❑Ct rwy Boa 066we <br /> PUMP ❑Sob mersible ❑Turbine ❑Other HP Pump Sd R Swtding Walal<vel R <br /> WELL DESTRU '()Ri ❑Disco Bolam O Gravel Pwk ❑Uncased ❑other <br /> well Domeier_in Tonal Depth A Depth to Water R ❑Casing to be Perforated from R in R <br /> Saling biennial 0 Nat Ccmcnt(91 lh bag13-10ga1 water) ❑Said Cement .sack ml,/7 gal it, ❑Semitic Police <br /> Cl Batenia(20%solid,) '❑Mwu6ewer Spec%wlidS % Heme ❑Specs on File O Span Submined <br /> Placement Method ❑Pumped ❑Fra Fall OOther <br /> ❑Complete with Musbrose Cap A beluw grade O Complete an Earning Sur6ce Pad <br /> 1 HEREBY CERTIFY THAT 1 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 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> /1c MINI/MUUM;L4 HOUR ADVANCE NOTICE`REQUIR(ED FOR INSPECTIONS �'^ q <br /> Swn[D I/ I(i T✓T �I��/�u.D TME 1�.LIX"), DATE 15 —/3'E� <br /> JJ ing <br /> E <br /> -DCPARTDate USB,ONLy <br /> AppliGtionA B Date syr/+�-(J/{/sA'L� A,a Employs lW 3r3af <br /> Gmus Inepeerion By Date 0 SPECIAL Well Permit _//l y <br /> pump Inspection By Date 0 WAIVER Received 1 / <br /> DumKdo.Inapstion By--_ _ Date Co strueted Well Depth n <br /> COMMENTS Q ' h Zoth, /fit - VS <br /> PE SC ReeeNtil s Amount Dane ayaap Wet11ON <br /> Code Into 11ash Readmit rNeeR uestp <br /> I T— <br />