SU0008582 - Laserfiche WebLink

Home Browse Search

WELUPUMP PERMIT t SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT bog EAST MAIN STREET.SMCKTON CA 90M-(209)46"421) NON-REFUNDABLE PERMIT i�J Ai I 208 953.7697 FOR INSPECTIONS a 9 EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS _.._ }-{'W 't {�,Q 'y...d'- .i cnyjzIP�1 IL4 00A . Sj^}?� IA CROSS STREET APN S-O-f PARCEL SIZE OWNER NAME -tCJ .LAND USE APPLICATION# ��Q`1N �/-, W\'P S _ PHONE OWNER ADDRESS A �' nom- CRY/STATEgtP ` CONTRACTOR �L. ❑. 4-a'QEti�'.�an3 ASSOC�1t�'-[fig PHONE 00k 01 CONTRACTORADDRESS q o Z any tj LtiS`TTc t s4 t� w I CrrYISrATE ZIP_ "01 C_-_ SZ`t SUBCONTRACTOR PHONE - SUBCONTRACTOR ADDRESS CITT!$TATEMP t LICENSE C-57 ❑G61 ❑0-09 13 Other NUMBER (e)6'k_00q EXPIRATION DATE i GEOGRAPHICAL INFORMAYpN: Coordinates X Y Township Range Section r INTENDED Use D DOmestirJPrivate ❑IrrigaftVAgrlcultural .Q Industrial ❑Water Quality MonitoringA SamplfngvOharacwzation D Public Water System ttdinemrtfrom Owner: r Y OM « u TYPE OF WORX ❑New Well ❑Replacement Well ❑Well AltoratlonrModiBC,ation ❑Other D Monitoring Well(s) #of wells a Soil Bonng(s) R of borings geotechnical _a of bodnas D Out-OfService well ❑Out-(N-Servlf a Well Renewal p CtOSS-CDnnecGan Repair ❑New Pump d Pume Replacement ❑Pump Re air D Raise Well Casinor� WEu�ONsrnucnoN Drilling Method ❑Mud Rotary D Air Rotary "ger ❑Cable Tool ❑Push Point ❑ Other O Proposed Well Depth 10-,(!S fl Excavation_ In diameter ❑Open Bottom 0 Gravel PacktGravd Siza in diameter D Conductor Casing in diameter ! Conductor Casing Depth ft - �] Wall Casing Diameter_in ThiWmess/Gauge/ASTM Schad U Steel ❑Plastic ❑Stainless Steel ❑Other I� I Grout Seal Depth It ❑Neat Cement(94 lb bag�5-10 gal watery ❑Sand Cement 88gr rnL�7 BN Mrdter 'I T ❑Bentonite(20%Wlds) Y-Other N oLp_ lot �LpI.riWJ W y-7L Grout Placement Method D Pumped 2Eree Fall ❑Other 0 Retardant/Accelarator(name) PsossTAL Installed By` []Driller D Pump COntractor D 0 to Concrete Pedestal Dimensions:Width ngth R Thiels in ❑ChHaty Box ❑Stove Pipe PUMP D$utxnerslbleO Turbine q Other HP Pump Set ft Standing Water Level R i+ I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE 1N ACCORDANCE WITH SAN �t JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT IAM IN REQUIRED WITH ALL WORKERS COMPENSATION LAWS. t MINI UIVI HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED ..TITLE I �.� GT �l�-rrly DTE Q~7-8—ra If�i E 0 ji o E P71-HE T M F'NT — Applicatlpn AcceptedBy Date Z�' (O Area� — Employee ID# T L Grout lnspectonBy Date ❑ SPEcIALwellPermit 7 I Pump Inspection Date ❑ WAIVER Recefved Soil Boring inspecilon y Data 7� COMMENTS Catatnieted Well Depth $ f fll PE SC Received hoc" Amouni parmlH Codes info B es Remitted Date Service Request S invoice 9 Well IDI! q-37 (sem 2325 Ser-C.A29 p 9M0,3,06 . 6 s" VELLIPUMPPERMR F