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Y <br /> f 4!9904WELL 1 PUMP PERMIT <br /> SAN JOAQtma COUNTY ENYDRYNxI:NrAL Fie DErArrmun 6D0 E.MAID Street-T'4aw ON CA 95202-(209)4de3420 <br /> NON-REFUNDABLE PERMIT ` CALL Z09 953-7697 FOR INSPECTIONS �. .RES]YEAR FROM DATE ISSUED <br /> JOBADORESS r,=* 7000 W. Windmill_ CovJ Road Crryam•Stockton, 95206 <br /> CROSS STRRET Holt APN 131-220-09 PARCEL SIZEEi�3 LA1m Usa APrLtcAstvN fl <br /> OWNER NAME -Ina Dement Machado PHONE 462-2764 <br /> OWNER ADDRISS s me CrrY)STATMW <br /> I <br /> CONTRACTOR. Delta Pum PRONE 209-466-9625 I jI <br /> CotvrnAcTcnADBREss 646 S. California Street CTTY/STATPILR. Stocks n, CA 95203 I <br /> SURCONTRACroR PRONE I 'i <br /> SUBCONTRACTOR ADDRESS CITYISTATTJW . <br /> LicENsE 0C•57 XXC-61 aD-69 ❑Other Numiam 724778 ExmRATeON DATE 8/n) <br /> GEoGRAPHICALINFORMATmNt Coordiosles X Y. Township Rsage Section <br /> 1 <br /> Fit-=MEnUsE Mom_estic/Private ❑Wilation/Agricultu al Q Industrial ©Water Quality Monitoring 0 Soil Sampling/Chsrectetixuion <br /> 17 t'ublic lVeki Sysytem ., J <br /> [tdiffasatdv+aOw e" ystao ame, _ iuncw <br /> IIMQM oRK 13 New well D Ropinismnont well Q Well AlterationNodifteation 13 Other <br /> Q Monitoring wdH:) q of wells 0 sou Borin&) a orbarngs CI Geoteehnieal a of baricgs <br /> 0 0awfSorvice Well ❑Out-Of-Scrvie;Wall Renewal 0 Cfass.Connection Repair 'r j <br /> I ❑New Pu 3CdPum lacetttettt 13 Pump Repair O4 <br /> WELL Nstu[,cnoN - <br /> j Drilling Method D Mud Rotary 17 Air Rotary D Auger D Cable Tool Q Push Point D Otber <br /> f Proposed Well DWh fl • Excavation insiameter 00penBottom CF Gravel Pack/Gravel Sae in diameter <br /> f ❑CooductorCasing indiameter 1 Conductor Casing Depth, ft. <br /> Well Casing..,Diametor io Tbic6.&U9.60ASTM Sebed C3AWC1 t7 Plastic O Stainless Steel O Other <br /> Sand Cemenr sack mix/7 water <br /> 3 <br /> I <br /> Grout Seal. Depth fl D Neat Cement(94/b beg/S-/O gal water) D gal <br /> ' D Bentonite(20%sdids) , ❑Manufacturer Spec%solids _% Nam D Specs on File ❑Specs Submitted <br /> Grvat Plasemeat Metbod C)Purnpcd. O Fran Pall ❑Other ❑Retardant!Accolerutor(name) Z <br /> ply Installed ey ❑Driller ❑Pu np Contractor ❑ Othcr_ <br /> ❑Coaerete Pedestal DimeanI o-Width ft LongdftThtelIn ❑ChristyBox D Stove-pip. <br /> € I' Submersible C]Turbine D Othu F>P Pu Set 33 fl Smoing Waterl ave! 12 g r <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 CERTEFY THAT MY REQUIRED LICENSE IS <br /> ( CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL 7 <br /> WORKERS COMPENSATION LAWS;. <br /> t UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGPtED TITLE CEO DATE_ 08/25/08 ' <br /> go <br /> 77 It <br /> k <br /> I IP <br /> i <br /> I <br /> 1 <br /> 1 - <br /> D'E A R T,M E N Tq S E,�y,ONLY <br /> By.� M. ..D:tto <br /> By <br /> .Date E3SPECIAL Well Permit <br /> Pump11B ! Date ❑ WAIVER Received <br /> CoastructedWelt Depth .R - <br /> E COMMENTS. <br /> 19:z A <br /> J s <br /> I PESC lteeel`ved CG' Amount Permit/ <br /> k Code, [oro '13- Ca26 emitted Date Service Re uestp IavofeeN WeI1�Y <br /> � 5 �'�(� X5'0•a-r7 `� e,8 /ADD �s 3 0 2u'PoDe2 <br />