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WELL / PUMP PERMIT �' 1 <br /> SAN JOAQUIN COUNTY EN VIRONMEATAI•HEALTH DEPAR'IMUNI304 E WEBER AVF 3`°Fl.-STOCKTON CA 952112 - (209) <br /> N N-REFLINDARLE iomkllff CALL(20919.573-7697 FOO INSPLC•TIONS EXPIRES I YEAR FROM DATE ISS <br /> J� <br /> CROSS STREET V f APA, D V PARC'I,L S11F. L-%ND L'St APPLWA[ION# <br /> OWNLR NAM1 PHONE <br /> OWN ERADDRUSSAAA/]/��,�L _4 _ '/7�w,V'�,f CI'f1fS'IA'ft1LIP J��F/�j� 7• <br /> CONTRACTOR 1\rr�F 1 G1l.1,{// J - -- /� <br /> CONTRACTOR ADDRESS ✓ [��}a Gv l � CIT\'(STATE.LIF <br /> til.BC'ONTR,%CTOR PIIONF <br /> ISI.BCONTRY('I'OR ADDRESS (:I r\ISTATF_I IP <br /> LICENSE ❑C-S? ❑C-61 ❑D-119 ❑01ker _ NUMBER EXPIRATION DATE <br /> GVOC:RAPHICAL lNrORMATION: C'oordinales v v _- Township Range Section <br /> IyTENU1.11l1cF. nmcstic:Privatc ❑Irrigaunn:AgricultuW ❑Industrial ❑Water Quality Monitori ig Q Soil Snrttplink Ch,;rtcten; <br /> G PubAc luster S}SIM. <br /> I(ddlttr.!'runi -nri - 'w"ICI fICIY.h aim --- --Cars7 Narror Phone Number <br /> TYPa Or WORK 60Zie-w welI U Replacement Wdl ❑We11 ❑Teo Hole ❑Other <br /> CI Monitoring Wellt.sI P of Wells ❑ ♦aCbonrtglt 060wecrinm4d r ofecing <br /> ❑WeL Drstruruun D Uul-O'=Scoter Well 17 Chit-Of-Senicc Wcll Renewal <br /> plimp ❑Pump RCT.aCCmcnr ❑P%Ltl)r Rq air ❑Cruss-Conwevhun Repair <br /> 1 TI.1.CONSTRICTION <br /> Drilling Melhod ❑tvlud R n• 116Air Kowry ❑AugcT Plc <br /> Taal ❑Pus.)• Pairt [30111cr <br /> Proposed Well Dcptil `� R �jecavatinn m di✓amcter_ �Q1,en BLKionr [3 Grovel Pack i Grilve.l Sur In <br /> O Conductor Ca'ng /� in dianwwr t Conductor Castng Depth 11 <br /> Well('asing Dtametrr� in lhickresahuuEe+ASiM Belied E I ❑Plastic ❑Sta:Illc99 Stccl ❑OtteT <br /> Grout Seal Dcptn It ❑Meat C'emInt(94 lh hag.: If)gal Wjfer,i Sand Cm..cat yuck mit 7 <br /> ❑Renta l:c(=C';<solids.) 0%lanul'acn:rer Spec 44 solids % Nantc � ❑SPAS pn File D SpeA3 Su <br /> Grout Plwcemenl%1etho( d ❑Frce 1`3I'. ❑OEhcr ❑Rct:udant:A"Ovarlur(namcl <br /> Pt:ur:Sr�l Installed By a411%4i.cr 0021",mvContrac �r ❑01ECr <br /> 094,/cuncrete Pedestal Dinwitsions: Width_ n L.:ngtll ft T i.:k In ❑Chris.)} Box D Slovc Pil <br /> Pump corubmemihlc ❑Turbine ❑Chhcr 11P,_'95LO Putttp SU1S�' ll StarArig Water Level T!e le <br /> �- <br /> I IIF.RERV CF.RTIfV THAT I HAVE PREPARED THIS APPLICATION AND TIIAT TIIF WORK WILL BE DONE IN ACCORDANCE WIT <br /> JOAQLIN LOUNT1 ORDINANCES, STATE LAWS, AND RULES AND RJE:GULAIIONS. I ALSO CERTIFY THAT MV REQ13RFD LICEI <br /> CLRRENI' AND ACTIVE WITH THE CALIFORNIA C'ONTRACIORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WIT <br /> WORKERS COMPENSATION LAWS. <br /> 1,1jN4MIAll 2.1 HOUR ADVANCE NOTICE F QL.IRED FOR INSPECTIONS <br /> SIGSF., �� _ _ 111.1: DA'tL <br /> I <br /> Ax <br /> i <br /> i <br /> A. <br /> - — •- P111,4 �° �c <br />