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WELL/PUMP PERMIT {"��� <br /> { <br /> SAN JOAttum CouTv ENvmlcuaEIAL HMTB D¢PAR zw 306E WEBER AVE 3"PL-STOCKTON(�r2yu _a0R)C 3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR PROM DATE ISSUED <br /> JOBADDRER4w,n CrEv/ZI y <br /> CROSS STREET I APN �O PARCEL SIZEWND UE¢APNG/TIOQNM `y{{/��y/�� <br /> OWNERNA. JZ� PHONE�LYI/'L/JI�T Il J I <br /> OVNERAODREE5 (yam �/�/� �/1/- /1 9�I �,./�q �Cf(1�T1/�Sf/�A1lVGP f.. 4 <br /> CONTGCEOR U/YJY(I\I�J III�rJ Y/6� �'��.V--.�111`�-44` . I UO Q{PHON <br /> CONTRACPORA.EfS$ 2�/1/ I A.J I I W/�Ql CRv/STATEUJ E!�n <br /> SUBCONTRACTOR PHONE <br /> S AODR6S5 �/QST�AT/PI�LIP� 'v <br /> WceNSE C-57 ❑C-61 OD-0 OOther NUMBER 1 ExPtRAtwN DATc D <br /> GEO nU,FHICALINPORMATION: COONloafw X Y Towu.Wp_ RE.,_ Seal n <br /> INTENDEDUSE ❑Dmansic/Privatc O InigsdWAgricultuml ❑Industrie] O Wear QWi,Moulton, O Soil Sampling/Charn,tr aticn <br /> ❑Public WearS vton <br /> BE, Y6rtaem bora Own aw ywm em. Ba mea <br /> TYPE OP WORE ❑New Wcil ❑REplacmnrnt Well O Well Alwatios/Mdifiafton ❑Other <br /> ❑Moitorr'Weil(s) Bofwolls ❑Sml Bming(s) eelbain, ❑Gemechnial_A orton, <br /> ❑Out-0f--Service W I ❑Out-0f-smica Weil RaRmal ❑Cmww <br /> Lorzacn Rn air <br /> C,New Pum m R ]°cement ❑Pum R <br /> 3MLCONSTRUCIION <br /> Drilling Merhad ❑Mud Rotary ❑Air Roar, ❑Auger ❑Cable Tool ❑Push Point O Dam <br /> Proposed Well D,p ft Exavadon in diameter ❑Opu BOftmn ❑Gmvel Pack/Gravel Sine in diameter <br /> ❑Conductor Casing indism,er / Conductor Casing Depth ft <br /> Well Casing Diameter_in ThiclmesxWGaugelASTM Schad O Seel O Platic O Swinias Strel Omer- <br /> Grout <br /> merGrout Sul Depth 11 ❑Nat Ccumt(94/b bag 15-10 gal water) OSnnd Caunt sockma/7galwaw <br /> an <br /> ❑Bwtonia(20%solids) ❑Muficmmr Spa%solids_% Namc OSpuson Filo ❑Specs Submiud <br /> CrVRt Placemen]Method ❑Pumpd ❑Free Fall ❑Other ❑Retardant/Accelerator(no=) <br /> PM AL Insml"d By O Driller O Pump Cootrncar O Other <br /> ❑Concrete Pedestal DimewlonEWWN ft Longth-ftnick-in OChriNy Box OSIOee Pipe <br /> ,orae Submersible OTmN.r ❑Otho HP_ Pumps ftSmmdwg Waw Level ft <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 /> WORKS COMPENSATION WWS <br /> INIMIOU 24HJQURADVANCENOTICE REQUI ED FOR INSPECTIONS <br /> SIGNED T DATE -7 <br /> 'i <br /> 1 <br /> tE <br /> pp RT AFJ IT <br /> r <br /> 171 <br /> PA T r... USE �G <br /> Appliation Acceptd BSWA Daa Z Arm Employes IDB <br /> Grout Insput1W.ion By Dote ❑ SPEWANT WellPR"elVeEmit <br /> Pump lrspechw By Das $ ❑ WAIVER Received <br /> Canrtrucld Welypepf ft <br /> COMMENTS <br /> PE I SC Recdvd Cbe Amounl Perm"/ <br /> Codes Info B Ck Remind DBa Service uwep InvOlaB Well mg <br /> I So SY Sll, I 50�`4 A. 7 <br /> NNlld]OH WELL PUMPPFAMR <br /> imaam <br />