Laserfiche WebLink
WELUPUMP PERMIT <br /> SAN JDAQUW CouNTr ENviRONMENTAL HEALTH DVARWMT SOD EAST MAN STREET-STMKTON CA 95202 -(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL.(209)953-7697 FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUED <br /> Joe A.voeEss omlb — P. 1, '�I " Ln YMP., /5I!Vq2cXTDJJ r 952A 7- <br /> CR <br /> CR SS.r ET I��ZH_T NULL " APK Qtj <br /> OWNER NNIS RA to %NwrJ • 1: PHONE g <br /> OWNER ADORES2 \L027. C. lora Ker ttJJ CRYISTATEZp. lC14, 95-LlS <br /> CONTRACTOR JJF_I L. ClAPL)IME1L 10 i AS SLWf IA-[6f PNONE� rI <br /> O -3 6'1 'm1 <br /> DDNTRADTOe ApORE1S_g�Tjji,)"yTttA W- - W ICm/STATEMP L-901I /_ A- 415240 <br /> SUBCONTRACTOR p11oNE <br /> SUBCONTRACTOR ADDRESS_ CrrY/STATEMP N <br /> LMENSE >(C57 U C-61 D D-09 U Other. NUMBER AU ES .TIC.DATE-!fl pq <br /> GEOORAPHpAL INFOIg1AipN: C00r*Ih1K"X Y Township_ Range— Section <br /> INTENDED USE C DomealloPrivaOe C ImgaDcn/ASnn tura) C Industrial F Water QuelBy MonitoringSam n <br /> Soil <br /> xl pl p/Cheracner'vation <br /> ❑Publioma Byb%m <br /> narrerarsuom Ower: r rs m new <br /> TYPE Of Wa u, C New Well C Replacement Well U Well Alteration/Modhicatfan U Omer <br /> C Monitoring Wallis)__#Ofwelts ,Soil Boring(s) embus'•• TCGeolechni(al <br /> Out4x-Ser roe Well ri Oul-OISerrw Well Renewal 1-Cross-Connection Repair <br /> New Pump C Pump Replacement C Pump Repair <br /> WELL CONSTRUCti <br /> Drilling Method D Mud Rotary C Air Rotary PICAuger D Cable Tool C Push Point ] Other <br /> Proposed Weil Depth /D -1 S It ExcaYa9on_S in diameter 5 Open Bottom D Gravel PatldGmrol She in diameter <br /> �ConduatorGaii in diameter / Conductor Casing Depth _k <br /> Well Casing Diameter—in Thickness/Gauge/ASfM Schell U Steal D Piastre Stainless SWI ❑Omar <br /> Grout Seel Depth ft U Neat Cement(94 1b bsg/5-10 gel wafer) D Sand Cement saor mwT gai wafer <br /> ❑ Bentonite(20%solids) OCOtherSotL.._(dyTTlric,ci 4toLE ri-L-i e^ =F GrW <br /> Grout Placema d Method o Pumped Free Fall U Omer_ ]Rearderd/A=,jamfor(nam,) <br /> P€FV�y InM nes By O Omar O Pump Contractor 7. 6I�Omer <br /> ❑Concrots Pedestal Dimefulonc Wpm !E.Bnglh If Thick in u Christy Bos U Stwe Pipe <br /> Puaw ❑SuDmereleleC Turbine U OmM <br /> Other (y I Pump Sal ft Standing Water Leval k <br /> I 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. I 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 /> WORKERS COMPENSATION LAWS. <br /> /J , MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> TITLE eEbJFUT L`NGr//URE K.-DATE Li-3-09 <br /> `as POR. SEAS J A 4 T.2N. R.k, MD.S.drM. <br /> am <br /> am <br /> e <br /> oB <br /> MLE <br /> DE A MENT UillEIONLY /'q <br /> lrcoapad DateAma Employse t-f <br /> InsplNt!on B Da% 71 SPECIAL Well Permit <br /> Pump Inspection By De% ❑ WAIVER Received <br /> SW Boring Inspection BY DataConstructed Wee Depth ft <br /> COMMENTS -L��L/rA.LS <br /> PE 9C Received C Amount ParmW <br /> Cedes Into ash Remitted Data S.I Re ,este IwWeee Welly <br /> LJ <br /> EHp FYae WF LAUW PERMIT <br /> 92007 <br />