Laserfiche WebLink
g <br /> SAN TOAQCJIN LN:AL HEA�.mH DI5 1tIC <br /> Ok` OFFICE �JSE� :,,,.._ 16O'1 E. Hazeltori Ave: ; Stocktbr ; Calif: <br /> - .,.. .� 6+81 ..:,-, ,,:•:_, P'ei'�t � ��: 33 <br /> A P ICATIOI4 FO'R' WELD. CONSTRUCTION Olk PUMP P$RMIT <br /> r, k <br /> THIS PERMIT EXPIRES 1..YEAR FROM,D'ATE ISSUED Date Issued <br /> (Complete Iii TriVif ate} s 1'' ; i;" <br /> Ap' licatioti' sib teb i'faade tp' the Saar Joaquin Lacal I e'alt� Distr- ct for a permit to c_vi q <br /> z <br /> �. <br /> atn , or install- ttwtiik herein descried This app'1iatiaii' is made iii' 16Pxocal]eIi�atD" sc ': <br /> Cb'fi{ity Orciinat N X86'2 dfid e 1e' air eg ilatib s of tie San Joaquin E <br /> � g <br /> 0� South Grace, <br /> 500` East Markets 150' North Fron'FCEIVSTx5 TRACT �_ <br /> JCB' ADDRESS%L� ATIII - , <br /> Tib. Claude Potter <br /> , 6 6 <br /> Address 20193.E•._ y. 2 9 <br /> Li4y �''. - - y <br /> nde Ca�.�.f, 9523. . „� �,. ___.. w <br /> ,. <br /> Cti itractor"s e Puryiance Dri3lers,P.O. Box 64j,indenjCalif.L4cense' 4 ,240'107 Phone 93 1x46$ ; <br /> TY'E OF WORK (�Ctieck) STEW ____ _ / F DESTRUCTIONI <br /> „_-„�.k.,,�=„.._.�. - - UMC'' REPLACEMENT f_7 <br /> r <br /> WELL �� DEEPEN:'. / _ RECONDITI <br /> PUMP INS�'EILLATION 711 P� RAIR / P <br /> r <br /> �:” Other /, . /I _. __.._Y w ••:_ ,.. -_ ^., <br /> SE4JER�'L'INESh 3 3 _ P T`: PIt`M7 --- _—_ �►:. �. _, <br /> DISTANCE TO` NEAREST.! SEPTIC TANK _ , <br /> i� rte.. -_ _. <br /> S'EWAGEl DISPOSAL( FIEL�� r CESSPOOL/SEEPAGE PIT' OT R .__ <br /> PUBLICa_DOMES�'IC �IE�;�;�`��.;=�� <br /> CONSTRUCTIONS SPECIFICATIONS ----- <br /> INT'ENDEDUS'F, TYPE OF WELL.. - . <br /> Industrial _ Cabld,f- oil Dia of Well Excavation+ <br /> yaaII s. <br /> + < '; ^ S Dolled` Dia of Well' Casing( <br /> Uamestc� vs <br /> I}dwesit / iii i i Driven Gof <br /> auCasing - <br /> t h w <br /> -� Gravel.Pack.� f}epfhlo�` Grau't <br /> Irrigations - - � <br /> U146 <br /> co�tec: =lori Rotary4 YPe af' Groin` Other <br /> ,_ Surface''=S'ea Insta' .- <br /> ,�-Geoph�s;�ca .. � <br /> �ON Cont -- - - -- ��.: �-•.�,.:.m: <br /> PIMP -i iSTA�.I,A.. .! .I s (actor- w — H':Pfi : <br /> of Pump _ <br /> . �s �i�- 1:;�. �i+a �' .�. s3- r`i nose F-- »r,•`°.�".. <br /> P. REPLAC� NT': 1� I <br /> S,t Work Do <br /> PUMP REPAIR �� � State - <br /> _ roxiui t g p h 831 <br /> ra l-. F aiixx f:a! al u,. [„- �-f- }i},►1 - <br /> r� PP <br /> Describe--Material -and Procedure Feet-sememt -Pumped in -` <br /> I hereby agree to comply <br /> with all laws and regulations of the. San Joaquin Local Health .District <br /> and the State of California pertaining to or regulating well construction, Within FIFTEEN DAYS <br /> I' .tion. of my work, on a new well, I will furnish the San Joaquin Local Health"Dist'riet a <br /> after comple <br /> f WELL DRILLERS REPORT:;�of' the well and notify them before putting the .well in use. The:�above <br /> information is true do the best of my knowledge and belief. I WILL CALL FOR A GROUT. INSPECTION r <br /> PRIOR TO GROUTING • A FINAL INSPECTION. TITLE �U # <br /> h <br /> SIGNED <br /> B W PI+ T PLAN 'ON RE ERSE SIDE <br /> FOR DEPARTMENT USE ONLY <br /> PHASE I %] <br /> I �Z DATE � 7 7� <br /> APPLICATION :ACCEPTED BY <br /> ADDITIONAL COMMENTS: PHA II/XIbjAL II/XIINSPECTIOIJ <br /> PHAS II RO T INSPECTIO <br /> INSPECTION BY DATE INSP�:CTION BY ATE <br /> 3/76 T2M <br /> - <br /> E H 142- <br /> _ <br />