SU0012295 - Laserfiche WebLink

Home Browse Search

WELL/PUMP PERMIT SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISIONQAYMENT 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 FRECEIVED rt^ MON-REFUNDABLE PERMITFXPIRFSIYEAR FROM DATE ISSUED �pN; JOB ADDRESS ;S�x=�br�a,:p,-� •� �`, OCY 1 4 2000 PARCEL SIZPIAPN Cl CYlZIP h.Z $Ali JOAOUIW COUNTS♦ OWNER NAME 0150 ADDRESS :2-7.5 L � s�sE PU(tu1GNT?L HEAITN DNISION CITY/ZIP PHONE y� CONTRACTOR n em S � P Cpl-1�`i£ CITYIZIP PD b424 PRUNE S s S �O Jam. GEOGRAPHICALINFORM[ATION: COORDINATES X Y TOWNSHIP_ RANGE_SECTION TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL.# ❑OTHER INSTALLATION: FELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR,EXTRACTION WELL# TYPE OF PUMP: ❑ NEW XREPAIR H.P. DEPTH PUMP SBTX "i ffFT. FIRST WATER LEVEL 2190 ❑OUT-OF-SERVICE WELL Cl GEOTECHNICAL# ❑SOH.BORING 11 DESTRUCTION: INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA %(DOMESTICPRIVATE ❑GRAVEL PACKISIZE WELL CASING TYPE 36=1 WELLCASINGDIA ❑PUBLICJMUNICIPAL ❑DRIVEN GROUT SEAL DEPTH SPECIFICATION 24 HR N(D-FICE` IV IRRIGATION/AG R E Q U�STE L7 OTHER GROUT BRAND NAME ❑MONITORING FCD R ALL GROUT SEAL PUMPED: ❑YES ❑NO ❑C[IRISTY BOX ❑STOVE PIPE I N S R r= -f-1 C7 ISI S CONCRETE PEDESTAL BY DRILLER: ❑YES ❑NO APPROXIMATE WELLDEPTH CNK PROPOSED CONSTRUCITONIDRILLING METHOD: MUD ROTARY_AIR ROTARY AUGER CABLE_OTHER I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN 11 JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. J SIGNED: b TITLE: DATE: �I �A r7 " 4 A. DEPARTMEN SNLY Application Accepted By Grout Inspection By Date__ Pump Inspected By Dute t� Destruction Inspection By Dutc COMMENTS: PE SC AMOUNT H RECEIVED DATE. .�� 'ST n WELL ID# CODES INFO REMITTED CASH BY _ 3 — i a oo � 17