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WELL/PUMP PERMIT <br /> SAN JOAQUN-MUNTY PUBLIC HEALTH SERVICES FNVIRONMENTPrCHEALTH DIVISION <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS 5950 East Woodbridge P,oad APN r <br /> CITv21P Acampo, 95220 <br /> PARCEL SIZE <br /> OWNER NAME Woodbridge Winery ADDRESS P.O. BoX 1260 <br /> C17•Y21P Woodbridge, 95258 PHONF-209-369-5861 ext. 2754 <br /> CONTRACTOR V&W dr i 11 i ncr ADDRESS P.O. Box 41 <br /> CITY/ZIP I s l e t o n 95641 PHONE 916-777-4100 C-57 LICENSE# 7 2 0 9 0 4 EXP DATI -3 0-0 <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE�J'E SECTION 3_2.— <br /> TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL 2_____' MONITORING WELL# ❑OTHER <br /> .- INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW ❑REPAIR H.P. DEPTH PUMP SET FT, FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION: <br /> INTENDED USF, TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OP12N BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA <br /> y ❑DOMESTIC PRIVATE 016RAVEL PACK/SIZE;A9_�/1 z WELL CASING TYPEY61 4WELL CASING D1A��,T-_ <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN SQn <br /> ��; GROUT SEAL DEPTH� SPECIFICATION <br /> ., <br /> CI IR/RIATION/AG ; � ��I `' OTHER GROUT BRAND NAME <br /> I�' ONITORING 1; GROUT SEAL PUMPED: Q"7ES' <br /> ❑NO <br /> EeCliRIM BOX ❑STOVE PIPE ' �Sl '' CONCRETE PEDESTAL BY DRILLER: ❑NO <br /> APPROXIMATE WELL DEPTH <br /> PROPOSED CONSTRUC'T'ION/DRILLING ME } <br /> Tl "�MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I IIAVE 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 C-57 LICENSE 1S CURRENT <br /> AND ACTIVE H THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSATION LAWS. <br /> MI M2 UR ADVANCE NOTICE RE UIRED FOR INSPECTIONS <br /> SIGNED TITLE DATE (` <br /> D.16ACKS <br /> cl <br /> MW6 \\\\\ \\ � 1� \\\\\\\\\\\\\\\\\\\\\\,\\\\\\\,\\„\\\\\ <br /> 9 \�11�\L1\sem`\1 \��♦\111` ".�1�1]?\11��1L\\Z—. <br /> mwl <br /> MW4 IBM <br /> I r� J• <br /> APN <br /> • b�Mus '•1]L\\,\\\\\\\\\\\\\\\\\\\\'l.y- '`' '–'� �• - <br /> MW5 <br />