Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION pump <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 93202 (209)469-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 13209 Nest Grant Line Road APN 2( Z ej z <br /> crry/LIP Tracy, CA 95376 PARCEL SIZE I— <br /> OWNER NAME Peter Parineh - ADDRESS 333 Hegenberger Road, #888 <br /> CrrY/zIPOakland, CA 94621 PHONE 408-857-1080 <br /> CONTRACroR_ Clark Well, .Inc. ADDRESS-024_ East Charter Way <br /> crrvrzw Stockton,. CA 95205 PHONE 209-462-7676 C-57uCENsEr371560 _ExpDA' x/04 <br /> GEOGRAPHICAL INFORMATION: COORDINATL?S X Y TOWNSHIP_ RANGE—SECTION <br /> TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL M ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL e <br /> TYPE OF PUMP: 2IXNEW ❑REPAIR H.P. 113 DEPTH PUMP SET 28' FT. FIRST WATER LEVEL 8' <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL$# ❑SOIL BORING ❑riRMUCi-ION: <br /> INTENDED USE TYPE OF WEL1, CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA_— CONDUCTOR CASING DIA <br /> XXIDOMESTIC PRIVATE ❑GRAVEL PACKISIZE, WELL CASING TYPE S t-Pt,1 WELL CASING DIA 8" _ <br /> ❑PUBLICJMUNWIPAL 13 DRIVEN GROUTSEALDEnH SPECIFICATION <br /> ❑IRRr5AT1ONIAG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROUT SEAL PUMPED: ❑YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRIlI FR: ❑YES ❑NO <br /> APPROXIMATE WELL DEPTH 43, <br /> PROPOSED NSTRUCTIONIDRR-LING METHOD: MUD RoTAhY AIR ROTARY AUGER CABLE_OTHER <br /> I HE CERTIFY 'TPA PREPA D THIS LICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN O A CF ,STA S,AND LES AND REC<ULATIONS. I ALSO CERTB)Y THAT MY CZ7 LICENSE IS CURRENT ` <br /> AND ACC THE AL IA CTO TATE LWENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENS:4TION LAWS. <br /> I ISI 2� A INCE NOTICE REQUIRED FOR INSPECTIONS p <br /> SiGNeD .ITTLE Sec-Tres DATE 6.5 02 <br /> t � <br /> @L4 1 n <br /> i N`JI'3h <br /> i <br /> L <br /> -t <br /> - i - <br /> 7� <br /> DEPARTMENT USE ONLY 1/� <br /> Application Accepted By ,v `' - _Dalt G� Att_a�-EMPID0If <br /> Grout Inspection.P.y -. -__Date Pump Inspected B _Date <br /> Destruction Impection By -_- Date <br /> COMMENT&_ ---- <br /> PE SC AMOUNT CHP.(;_ W RECEIVED DATE PERMIT/SERVICE REQUFSTN INVOICE* WELL ION <br /> CODFS INFO REMnTED C CAS BY <br /> r <br />