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VB ELL/PUMP PERMIT g 6L <br /> r SAN JOAQUw COUNTY PUBLICHEALTHS®2VICPSENVIRONMENTAL HEALTH DIV <br /> 3 E.WEBER AVE.TREND PLOOR S fn`ON CA 95202 (209)4A5-3420 <br /> NON-AEPONDABLE PERMYI EXPIRES i YEAR FROM DATE LSSUFD <br /> JOB ADDRESS 99 E. BLEWETT RD. —AN -?-- 5fKO0/?i <br /> �.r� TRACY CA 95304 (VERNALIS) PARCELSmE <br /> OWNERNAME JASON PEITZ .ODRE9s <br /> crrr� 99 E. BL EWETT RD. xoNE 832-7529 <br /> cormu R HFNNINC,S HROS DRiI I INRDw s 3595 PFI ANnAI F A-VE <br /> cn au MODESTO, CA 95356 PHONE 832-7529 C-57LICENSE# 290813 EXPDATE 5-31-D4 <br /> GI RAPIICAL INFORMATION: COORDINATES )I Y_TOWNSmw_ RANGE_SECFION <br /> TYPE OF WELL: XIX NEW WELL 6 X REPLACEMENT WELL ❑ MONnORwG WELL# pOTIPR <br /> r INSTALLATION: UWELLSYSJEMREPAEt pCROSSLONNECT REPARI pVAPoREXTRACTION WELLM <br /> TYPE OF PUMP: ❑ NEW ❑WAIR H.P. DEPPH PUMP SET FT. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOLLBORING OIDESTAUCTION: 6"XB91 <br /> r INTENDED USE 'rvvw.OF\VFJy. CONS's'AUGTION cpF/'IF)CATION BENTONITE <br /> p INDUS)RIAL ❑OPEN BOTIGM WELLEXCAVATIONDIA 14" CONDU=RCASWGDIA__ <br /> X)POMESIIC PRIVATE XI GRAVEL PACWS� WEILCASwGTYPEP1IC WELLCASINGD)A 6" <br /> ` ❑PUBLICIMUNICTPAL ❑OMEN GROUTSEALDEPIHO1 0T SPECWrADONR 0 .001 <br /> D BUUUADON/AG O MGROOPBRANDNAME BARIOD-Quick Grout <br /> p MONOORwG GROUT SEAL PUMPED: X)YES ❑NO <br /> r ❑CHRIS)Y BOX 0STOVE PIPE ` CONCRETEPEDESTALBYDJULER: DYES 1A NO <br /> APPROXPIATE WELL DEFTH— iitr 140 <br /> PROPOSEDCONSTRUCDONMRB.❑NGMETHOD: MUDR0TARYA1RR0TA1tY AUGER CABLE_OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TILS APPLICATION AND TRAT TILE WORK WA.L BE DONE w ACCORDANCE WITH SAN <br /> "ACTICOUNTY ORDINANCERIA O'DWS,ANDR TA AND REEBOARD AND <br /> ALSO I AM IF YTIATMYMVLICENSE WCURRENT <br /> AND ACTIVE Wf'I'H TFffi CALIFORNIA CONTRAC[ORS STATE LICENSE BOARD AND THAT I AM w COMPLIANCE WITH ALL WOAKINAN'S <br /> COLE NOTICESATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> .. SIGNED $� SUPERVISOR DATE 6-10-02 <br /> bA G G C <br /> fi <br /> 1 <br /> S <br /> r . <br /> C <br /> 5 P P <br /> U P1. <br /> L, 0 <br /> L, DEPARTMENT USE ONLY �y <br /> Al p4c# m Acc P2# <br /> Gv"ui Wsprcuo"e �✓ I TwpImP�EY etc <br /> Y. Dwvucum J"vpcctisa By po," <br /> COMMENTS: �.. (JylrAa taGw/ (f - �Lra..srCacL.�- "%� /Eilr� - hw,rz is (-rte-nary <br /> 6 <br /> PE SC AMOUNT CHECK#/ RECD m DAIS PERMR/SERVICE REQUe.SPM 1NVOJCB# <br /> CODES RIM REMJ=D CASH BY <br /> 9ov u 6t 3�$ INP P 25bg3 <br /> c*3Wit; 7 <br /> 216715 A vo Un <br /> L <br /> -------------------------- -------------------------------------------------------------------------- -------- -.._. <br /> - ---- - - - - ---- - <br /> FinalInspection by: ---------------------------------------------- - ---------------------- --- -- -.. .- - - -- ------.Date .._7. .r�- -- -------------- <br /> AAAI In AnIIIKI InPAI LICAITLI TDIn <br />