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�m r WELL/PUMP PERMIT �/ <br /> S&S JOAQUM Cents ENVIRONMENTAL HEAL116EFARTMEM SDI E WEBER AYTS-FL-JBRERTQN CA 95$QJ-(31N)466J130 <br /> NON-REFUNDABLE PERNI T CALL(209)953-:69 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS � <br /> 19.59 6,s+ McAllen Cmav S}o�y-lcit yS217 <br /> CROSS STREET IN4rA5 APS 092 /`10a PM[[L Sp2 <br /> 39 7 0 <br /> Got-3-S l <br /> DMN[R NAME G sa�rry I N <br /> S`J/D G Hwy 2(r LTn SrAisnv Sft <br /> CA 95a it <br /> OwN'CR AODRESE I <br /> CONTIAROR Advo�Sn�cn, 16e2F-ny(�-rD enenk, l (} E y67-100(a 'l/) <br /> GONTMRORADDR/EE`S 8J f SPT4FJ R� CT'ISTATEa1 J• C J CA 15�1,J <br /> SUBCONTRACTOR ` &SC']S 10''ESeDr/'�1\.Yl p Pxa+[ 9/(o/-�(n38-A11VY <br /> SL'KONTRACTOR ADDRESS .J(pJL VfT'T P-G Grc le CT'/STATEaR F- ACA .o CDC"l C Q 16711 F <br /> NtIOER ERfIRATIOn DATE v <br /> LICLtTE TIE-57 0 C4 0D-09 13 Other It- <br /> G[OOwxseAL lnrORnunon: Coorciie.tes X Y Township_ Romp— Section_ <br /> L TENDED UsE ❑DomesuNPrivate ImgadaNAgrieulturd ❑ivusubl ❑tl"ve,Quali7 Mmit>iq ❑Shc Bunpbng Cdracreriation <br /> Cl P bl,,Were,Sym.. 3 <br /> Bart <br /> T1TE OF WORK ❑New Well ❑Replacement Well ❑Well Alteocen Nlod-fimer ❑Test Hole ❑other <br /> 13 Monitoring W<II(s)_ ""tuna ofwdb ❑Soil Brrica(s)_ —n., ❑Ocotcchnial a afbom°a` <br /> IDILW.11 Destruction ❑Out-04Se,vice Well ❑Om-OfServee Well Renewil _ h <br /> E3 New Pume 0 Pump Replacement ❑Pum Rrua= ❑Cmn-ConncaionRepair <br /> \VELLCONSTRUCTION <br /> Drilling Slelhod 0 M Rotary ❑Air Rotary ❑Auger ❑Celle Tut ❑Push Point 13 Other <br /> Proposed Well DcptlrR Excavation in dunce' 13 On Bottom ❑Oravel Pack l Dowel Siec L.dmextcr <br /> ❑Conductor Casing in diameter / Condu.—�r Cuinx Dr,:� ft I <br /> N%01 Casin6 Diameter in Thl[k.cSoO.URe/ASTM Sled ❑S:col ❑Plastic Cl Stardom;Sted DO — <br /> Grout Scot Depth R ❑Neu Cement f9J/h dug J-19VI•nun [3Sand Cemem s k Amu <br /> ❑Bemomm(M,FeDds) ❑Menufaclurer Spec% oli!s_ Nzx ❑Spasm File 05pecs Submitted <br /> Grout Ruemem Method ❑Pumped ❑Free Fall ❑Other ❑Rr dant/Acceleraa(name) <br /> PEDESTAL Ivulled Be Cl Driller ❑Pump Conus.<r ❑OCner <br /> ❑Concrete Pedestal Dimensions: Width ft Ler..-5 ft Thick in ❑Christy Bos ❑Sim e Pi <br /> R'w ❑Submcntble ❑Turbine ❑Other tD,_ Pump Set_ft Staiding Wa,,Lesel ft <br /> WELLDESTRUMOP ❑Open Bottom ❑G.'C,,c]Pock 13Crcaud 13 Other <br /> Well Dumetef (�in Total Depths R Ord+:.N"a_rft ❑Cuing to be Perfaacd from_n to_ft <br /> ScallnB M1l.lerml ❑Neat Cement(P41h Mg'S-ID gut waxer/ `As.d Ccrftza25 dmu/7 gal wine, ❑Bar.."Pelle¢ <br /> ❑Bemmrne(2DS solids) ❑Manufacturer Spec••/aobds Ns.< ❑Spasm Fde ❑Specs Subrmtted <br /> Plammenl Method $lumped ❑Frm Fall 13 ft" <br /> with M. C11 <br /> Cap It below grave ❑Complete to Eae iN Smfase Pad <br /> 1 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CORRENT AN A IVU\\'ITII THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS 1 .AT10.\'L,1WS. <br /> XIINI 4I101A ADVANCE NOTICE REQ1L rI^HED FOR INSPECEICJNS <br /> SIONE TITTLE n'I FOr 0,,,^er DATE 10—;LI-03 <br /> I <br /> I I <br /> I <br /> e <br /> t } <br /> I <br /> n <br /> e Prf NS!ON <br /> I p � <br /> I 'J <br /> DEPARTNIL\T USE �s O t <br /> Applicaien Accepted By Due (p— .03 Area �/4 Emplq'ec� V/ <br /> Grout inspersion B Dec. ❑ SPECIALWeIIP<rmil <br /> Pump lmpecuBy Dae 13WAIVERRtceived <br /> Duwcuon lnaF<e4on Doc � ConprunM Wdl Depth R <br /> CONLNIENFS <br /> PE SC Amount Ch Ra<ivN D e Pamir/ /mom.N W'A IDN <br /> Codes Info R`em/itrted etch ev Sen ir.Renorit,tl <br /> { <br /> EHDe,34)2 06 Mss=Neto Nell Pemdt doe <br /> BCO,gOp3 <br />