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WELL/PUMP PERMIT <br /> SAN JOAoInN COUNTY ENVIRONM E NT A l HEALTH DEPARTMENT <br /> SOO EA$r MArN$TREE r-STOCMION CA e8202 -(209)t68-3120 <br /> NOM-REFUNDAB T GALL 3.76_7. 111 §FONPECT?UNS EXPIRES 1 YEAR FROM DATE ISSUED res <br /> Jae ADDRESS q a (� f <br /> APN A/ Q+.O � PAaCEI$,ZE - `^No ! 4roUrATlOw a•-- p <br /> CROee STREET ' --- <br /> PKONE <br /> Oki NAME <br /> Cra3tnrE rZlr — <br /> GINNER AODRESS i—� I{C, pp <br /> CONTRACTOR <br /> CONTRACTOR ADDREea — —• _._.-.__ ___ <br /> •••rfZrr <br /> SUIsCONTRACTOR -�___._ <br /> Cir Yl�ita rE f2lr---•__.-___ _ <br /> SuScoxrnACToa AtwREas„_. _.-_—_— -- <br /> tn r it __— EzPfRAnON DnTEly <br /> 37 OOC•61 D•09 <br /> LICENSE '. <br /> y Township-- Range Section-- <br /> GEOORAPMCAL INFORMATION: Coordinates G Sod Sdmphng/Ghardtlerliahon <br /> n!Tu!biIc <br /> sWr9:Ier0S.Ys1er` <br /> e 1+rrigation/Agricullural Inh,yr,al <br /> Wale,Uuehly Mnnnorin <br /> srenerJ..—...�.-._..__.-- <br /> r)Ilrrr <br /> TVP!OF WORK C New W1111ReptlICemenl Welt Well AlterotlonrModincatron a"f"onnss a ofbonnos <br /> Wells s of wells Sad Bonngisl- Geolecnnrcal <br /> r Monitoringl ) <br /> I, out-Of-SCMceell - Cul -Serv.re Well RCnewA1 Crpes.f unneCllpn RePau r <br /> Rase well CAsrng-•�.-- <br /> �• -.. ------ ' <br /> t. New Pum .�--••----- <br /> LL fflM CM <br /> Orllling Method - Mud Rotary Air Rotary Auger Cable 1001 Push Point Omer _^ <br /> Proposed Will DepiB _f% Escavetlon n diameter Open Bolton, 'hovel Pack7Gravel Site— in diameler <br /> r Conductor CII - <br /> res dlanwler ! <br /> Well Casing Diameter_ <br /> in ThlCkness/GnugeIASTNi Srhea Sleet olasbc Stainless Steel Olher <br /> GreutSee l Depth._ <br /> It t I Neat Cement(94 In"9/5-W gat waler) Sano .ement sock mr,r7 gat water <br /> L Bentonsle(20%solids) <br /> •OOter_ <br /> Retantanl AcCelrrat <br /> aeor Inamrl _ <br /> GropNument Method •Pumped r Free Fall_ -.--• ,-- -----.---�-- <br /> Instdlod By I Driller I Pump Contractor s gtn0� 1_441- <br /> +r •-' 1;n Christy Sof [IS(ove Pipe <br /> EIDLITA C Concrete Pedee's Dlmenslon. MdlnrYr 'r" - Y- � <br /> P r�Sub erciDlelI Turbine Other= I.IN n'r'Sri -._!--SlRndmg Water Leve'.n <br /> THAT I HAVE PREPARED THIS APPI.ICAT'ON AND THA; TI+.f: V411 L BE DONE IN ACCORDANCE WITH SAN <br /> I HEREBY AND RULES AND REGULATIONS ALSO CERTIFY THAT My REOUERED LICENSE 1S j <br /> JOAAUIN COUNTY ORDINANCES• STATE LAWS, I <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND !HAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LA <br /> I UM HOUR ADVANCE NOTICE <br /> pRRRE,OUIREO FOR INSPECTIONS 6 t 3 <br /> TITLE • 'F'^(� _70 DATE <br /> $gFkD +'—'�` <br /> T--r- i- <br /> + -- _7F <br /> I I __.I.._F <br /> -t r <br /> D E PAR T M E N T LSE}O!+L y , <br /> �u .. ._._ Oelo_ (ir. �3.. MCA_D �-L/ EmpinYeo IOa `7 Q Y� <br /> Alp0-_abon Accepted By —1L, I SPECIAI_Ill Permit <br /> GrouttnspecnonBy t 15' WAIVFR Received <br /> Pump lnspeell BY Dae __ -- <br /> ate Constructed WallUoplh D <br /> Sol 9enn01n o1 n By <br /> COMMENTS <br /> ------- —/ -r—^ —'�- PormlUWall IDN <br /> - rnvdree a —� <br /> PE SC Reciivod Choc nm Itle Deln _----- — <br /> aih RCmttled Sorvlco R/e-S•,r�n75t x <br /> Codes Info <br />