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`NELL/PUMP PERMIT <br /> SAN JOA=j CauNwENvutarns -HFaL-m D,,11T y868EasrHa237aNAVE4UE-STOm=?j CA9MS-(2B9)468.3426 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FORINSPECIIONS EXPIRES I YEAR FROM DATE ISSUED <br /> rn <br /> J03 ADDRrTaS <br /> 10221 E Baker Rd crr,•mP Linden 95236 <br /> CRossSTRl=tFerguson APN PMGfLS� / `I-ANDUSE APPL'rLMONR <br /> d <br /> Dosc_ he_rt� 9 <br /> OtvNSZNACL - PHOtt <br /> ov:v:xAODr1ss1 CrrrIsTATmP r- <br /> Rtn 'ktoP 95215 <br /> COMMACMR Purviance Drillers, Iac pxa„E 209-887-3554 <br /> Co:rraArmRAor) PO Box 64 CltvlsT._rdei'1nden, CA 952367 <br /> tSUacoNiaA=Ft PROM <br /> SLMcC)ATFRA=R ADDRESS Cmis-'ramp <br /> acarus 'V c s n t:st n D eg n Otirr� NDtsast 3 7 7 112 3 2WRATION DAVE /31 /1() <br /> ❑or�st*1;>nI�SA�Ptrrri D Genera(miner2UCoRfoun flactetfa(4391)--mmmochiompmpane(4392)=Arsenic(4393) <br /> Il=eMED USE 0 013— Rilrate nigalivnlAgrinilWrar G Industrial G WaterQualityMomloring O Soil Sanp6nglCharacler¢anon <br /> C Pubrm Water Syslem <br /> ltdaer¢n Fmm GY,ntr. .%?oersysL-m Mimn c==Nae or Fhc=N-Tbe, <br /> TYPEOFWORK G NWWeB C Replacement Well G Well Alter4knIMOdifieaflan3 Other <br /> :!mmdtorfngWeKs) PafvrrJLs GSoil8oring(s) Aaftm-Lz GGeotedmicat 3pf°O1 <br /> O Out-OFSeMce Welt ❑Out-0`rSeruice WeH Rene'raI D Crass-COtmeclian Repair <br /> C Neer Pump G Prmrp Repfecemenl `(Pump Repair 3 R21saVVe11 Casing _ <br /> aVF L CONsrRuCna.V <br /> �DrillingMethad O Mud Rotary G AirRatery D Auger n LShleTeol 7 Push Point . 011ier <br /> �Propased Well Depth it Excavation in diameter _n Open Bodam O Gravef PZGWGravel Sme in diz,nefer <br /> D Conductor Casing in diameter I ConduclorCasingDEpIh 11 <br /> Well Casing Di meter,_in Thir9messfGaug&ASTM Srhed _Steel D Plastic 0 Stainless Steel ❑011ier <br /> GroutSeal Depth ft -3 Neat Cernmt(94fbDaas70gal waWo 7 Sand Cement sack rrld7 gal viate <br /> C Benlanite(20%solids) a Other <br /> Grout PiacementGAethod D Pumped D Free Fa ❑Other =RetardantlAaeleralar(name) <br /> PmPsrAt installed 6y 0❑tIIler 3 Pump Contactor ❑ Other <br /> 12 Concrete Pedestal CDlmenslonsWidlh ft Length it Thick in '1GftdSVrBoz OStove Pipe <br /> PDArP <br /> 0 SItCmPJ5rbl6 Turbine 0 OUret HP Pump SetR Standing WaterLsvet R <br /> 1 HEREBY CE'RITFY THAT t HAVE PREPARED THUS APPLICATION AND THAT THE WORK WILL BE OHNE IN ACCORDANCE WFTH SAN <br /> JOAQUIN COUNTY ORDINANCES,STAT MWS,AND RUE-AND REGULATIONS. I ALSO CERIIEY THAT BOY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE VIITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I ABO IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> t <br /> u fI Z H VANCE NOTICE REQUIRED FOR INSPECTIOIUS-PLEASE CALL(209)953-7697 <br /> sty Corporate Secretaral <br /> A. � 1 <br /> I I I I I I I I I I 1 0 I 1 1I I I 1 f ! f I I ! <br /> 111111fillill ] fill II II I 11111 <br /> fl I [ 1 i ! I II II II I II II I III 1I I I <br /> lI Al I II I I I ! I I I I I I I I I I I I IIII ( <br /> III1141 1 1 1 1 II 1 I I 1 1 - I IIII I I f I <br /> I I I 1 1 I I I I I I I I I I I I i I I I I ) I I I i I I 1 I 1 <br /> 1 19 11 111111 1 1I 1 1 11 1 1 J -E-11 I111 I rI IVED <br /> I IIII Il II I i I III Il l ! 1111 <br /> I I I 1 1 ! I I ! 1 1 1 H I I I LIP 141 I 1 1 1 <br /> 11 i I I I I I I I I I I I I I 11 1 I I I I V 1 I ' I I i I 4U Ii <br /> III I I III It Illi I xe I 911 <br /> I 1 I I I I 1 1 1 1 I I I I I• <br /> I I l I I I I I I I I1' �-;N G;aUim <br /> r'ti9ENTAL <br /> I I I Tie Er,:,FfTFAENT <br /> II ! I I 1 11 II 111 ! II 11 <br /> DPi.ATMENT U E LY 1 <br /> �( <br /> Appfnzfion Astpted By � ��. ���. __Oate�� � � Area Employee t�-��rt'�-" . <br /> Grout Inspeciian Sy ' Date D Ec L WIll Permit <br /> Pimp tnsp-thm By n Date ' i- D }NA nfER Received <br /> SW Sating Inspection By Date Cansnucred Well Depth R <br /> COMMENTS <br /> PE SC Received L Checka;J fimouM PermrU V <br /> Dam f lmairra WLU ID <br /> JV <br /> - Info-._ — fr__. ----_-Cath .-----Remlded _ I S est: <br /> I I 91 :l <br /> II II <br /> I I <br /> I 1 <br /> 1 ► I <br /> ,-r-,L r-L-up PERU.. <br /> etaa earns <br />