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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE.. STOCKTON CA 95202 (209)468-3420 <br /> p NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSTIM <br /> JOB ADDRESS a6z9D/ /�Q .rti *- � 1 <br /> PARCELSIZE/APNN / CITY)ZIP� , <br /> OWNERNAMF. !Zh0 . P �ifT, -ADDRESS <br /> CITY/ZIP_. 4`/ 1 ( PHONE �3 <br /> C:ONTRAC'TOR ADDRESS_�y� <br /> CITYmp-&A& //� PHONE <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOW'NSHIP RANGE SECTION <br /> TYPE OF WELL: ❑ NFW W'FJ.L ❑ REPLACEMENT WELL ❑ MONITORRNG WELL a _O OTHFR <br /> INSTALLATION: E3 WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VArP�O�REX-'TRACTIWELL ON WL 0 <br /> TYPE OF PUMP: Q NEW ❑REPAIR H.P.1 2z DEPTH PUMP SET._ _FT. FIRST WATER LEVEL 14 4' <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL 0 ❑SO[L BORING ❑DESTRUCTION: <br /> INTENDED US 4: TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> [a'fNDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA <br /> L4e.ESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASINGTYPE WELL CASING DL4 <br /> ❑PUBLIClMUNICTPAL ❑DRIVEN GROUT SEAL DEPTH SPECIFICATION <br /> ❑IRRIGATIONIAG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROUT SEAL PUMPED: ❑YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES ❑NO <br /> APPROXIMATE WFLL DEPTH 0, <br /> PROPOSED CONSTRUCPIONIDRILLING METHOD: MUD ROTARY_AIR ROTARY_AUGER_CABLE OTHER <br /> I HKRF-HY CliIun THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCF.S,STATE LAWS,AND <br /> RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SICNCD: ��� <br /> T[TLE: 'le,Q�c -t._.' DATE: <br /> T <br /> I <br /> I I <br /> in fTw_ <br /> IY� _ <br /> L u <br /> 01,001 -ra N.k ' <br /> c IF NM FR <br /> IIEPARTM4NT I)SE ONLY <br /> Application Acccptctt By __ - Date <br /> Grow Inspection By Daae n:p Pulnslwcted ByDate. <br /> Destruction Inspectio B Dote-— --- <br /> COMMF.r%: Ut&j. ED(SrOL <br /> PL SC AMOUNT / RECEIVED DATF. PERM [/SERVICE REQUEST# WELL 11)9 <br /> CODF_S INFO REMITTED ASH BY <br />