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VVILIA ,/ PUMPPERMIT SAN JOAQUIN CODMY ENVIBONMENEAL I '.TH DEPARTMENT 304E WEBER AVE'" TTNKrON CA 95M-(2,1)4W3430 FNON-REFUNDABLE PERMIT �\ CALL(209)953-7697 FOR INSP CTIO EX •c��, i YEAR FROM DATE ISSUED �Am� \ \ " \ v� ` �' �/ /Alto � 4 r _`APN 1 • 1-29/JPARRCELSIEEA � \\�\h\ (� �j�� y �``� �a`�\v)WPIIIXi`E��1� `y1\��C PyCnr4CRYh1ATVLP X�q. Q—vi, R%,aNle%'E� CONrRALTORADDREEEB \�\s �� '��\\�l\ Nyy11.. CMISTATIMP SUBL-ONIRACTOR PIIONE SUBCONrRAC&RADDIUM `3\Qk Cfl'Y/STATL"Llr LIc:eNBE C-57 Cdl (3 D-09 ❑OUIes NUMBER S ly EIVIMTIONDATE t,\O `1 CEOOMPHICALINPORMATION: COBrddOhi X Y TwvrcMpi Reap Sicilian_ R1 INTENDED UEE ❑FAIR,Water Sx ❑Inigi tion/Agdcullure ❑IMuwtsl ❑Water QwlitY Monitoring ❑Soil Sampling/Chnacicdulioo Public,namrS Rmn,.rmm .mt. rcm sae rnt.t .m.m aK `�n TVPEOFWORc ONew Well ❑Replacement Well O Well Altmtion/MoeiOulion ❑Tau Hole 00ther v ❑Monitoring Well(s)__ mumle,M.dp ❑Soil Baring(,)_ "'"'he'OrI14'O1D ❑Geotahnkal m,mn.amd.D O WellDnuuction ❑put-0f-Savice Well E3Out-0hService Wdl Renewal E3".Pum Pu R lattmem Pum Reiner, ❑QoM-Conneclion R WEill.,Methed TION Ir DrIBIrlg Method OMm Salary 13 Air Rotary ❑Auger 13 COW.Tool DPuah Point ❑Other Proposed Well Depth fl Eanvedan in diameter E3 Onto Bouom OGre,cl Park/Gravel Sine in diameter ❑Comucmr tieing in diarneur / Cotducmr Cuing Uepeh B Well Casing Dumeler_in ThkkaeRVGaugdASTMSched ❑Seel OPlastie ❑Suinka Steel ❑Other Grant Seal Depth fl ❑Nat Cement f9e,IN bag/5.10 gnl sewer) ❑Sam C., erN*mu/]gel water ❑Bemmiim(204L solids) ❑Manulenurer Spec%solids_% Name— 0 Slnccs on Fik OSpas Submitird Grout Placement Method ❑Pumped ❑Free Fall 00111c ClReadanl/Auelentar(name) PEDESTAL IIWa1Md By ❑Driller ❑Pump Contracm, ❑Other ❑Contra,Pedestal Dimensions: Width_ It Length B Thick in O Chrim,Bei EI Rover Pipe PUMP Submersible 0Tirbine OOtho HP PRRPS.Aj'r" R $carding Winner Level WELL DesraurnoN O Open Kamm O Gravel Pack O Unceand ❑Other Well Diammer_in Tmal Drpth B Depthto Wats R OCAsingtobePManKdfrwn_flmlSLb-i;t-dft gcoune Materlal O Nal Cement INlb hug/5-10gu/wider) 0Sam Conant rack mu/7 gal warm ClBenmtile Pdko O Bemanite(20%r.101) ❑Manufarmtn Spa%solid,_%. Name ❑Spxeon Fik OSpm Placement Method ❑Pumped ❑Fra Fall D Other ❑Complete wish Mushroom Cep R below grade ❑Complete in Existing Surface Pad 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCE$ SPATE LAWS,AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. AT�,� MINIMUM 24 HOUR ADVANCE NOT(f�vREQUIRED�VIF1OR INSPECTIONS srcNEB TITLE C1�l�AnA DATE :T T TN Hf TH DEPARTMENT USE ONLY O Application A« lyd epBY Dme /0-07-0.2.. A. a'�7 Empwra lDB 684 — •6 Gout Llrpralion BY Date 13 SPECIAL Well Perml� Potion BX Da / •/2 .v L ❑ WAIV mp Inspecl ER Received ) , Dearoction Inspection BY One Contructed Well Depth B L-OMMENTS PE SC Amouul lase Received U.Ie Per.10 Cable Info BemlOed v Serdtt unto InvolmN We111D/ OS 7Soo r � Ib kGlo' 6 r EHD434Q-W6 SrtnODT q flu Pv/.lp �� MASTER WATER WELL PERMIT