|
"a" "alar. 16. 201.1 11 : 10AW Caneca & �^,1S No. X010 ?, 216
<br /> ■■� 4-111\I{(W� ;Lky1 ;-ICA-17 D+,►�
<br /> WELL/PUMP PERMIT
<br /> 3A JOAOUIN COUn Ty ENVIRONMENTAL HEALTH DEPARTMENT 1 h--D EAST HAZELTON AVENUE-STO;.KTON C A 95205-(20f))468.3420
<br /> NON-REFUNOASLE PERMIT CALL 205 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED
<br /> ti
<br /> JOB AODRE55 2E95fj S. ei td Road C1TYlZ1P_ Tta Cy, '353014 i r�
<br /> tCRGYY,$TREET W. Liam Road APN_ ?55,=0?0-54 PARCEL SIZE', AC LAND tl9EAPDLICAitON4 :ll
<br /> OWNER NAME ptl; TL=,troy g ,7X Tr P N
<br /> OWNERADORESS 72a!r
<br /> 0 Delay F:venin/r 2 q20
<br /> ciry CITYISIATEIZt�rl r,o S :;o, 1=L 32861
<br /> --- { .f ,
<br /> CONTRACTOR C'ANEP2i ANDSONS, INC. _
<br /> -- PHONE (7091 552-1134)
<br /> CONrRACTOR AoDREse 143E4 CUESTA +_O°3rRT 30:VGc'IA, CA 911"Q
<br /> _
<br /> SUBCONTRACTOR
<br /> SUBCONTRACTOR
<br /> —..._..._.._.. HONE
<br /> CITYfSTATEfzIP
<br /> LIC6N5E Y,C-57 C"61 D-09 Umar NUMBER 425749 EXPIRATIONDATE 7/31/1_6
<br /> GEOORAPHICAL INFORMATION: Coordinate(,X y Township Range---- Seclior,_
<br /> ltLZEE.En G UaE Oomsalir/Prrveta ,ng�,,; „',. al Industrial Walar Qualify Manilering f.:Soli Ssmpl:nglCtwracterizallon
<br /> PWic;Weler 1 yy ern
<br /> VadhteId(tca:C-1 n.t_ ,em MSM �_....�._., cn �y}7{yT(•PF.+n�f umEroi
<br /> TVPEOFWOAK XNaw Weil _ `'6Llar6m6nl Well wan Ali,raliorvmoo)fiCslian DOtne!_�_
<br /> Monaoring Wallis) 11 of wells 1,Soil aon, scroenng s >a
<br /> Li Gbo(echntcal korbcri. e
<br /> Oul•01-Setvice Wen i;Out-Of-Service Well Rune,val J GresSComeCt+on Repa,r
<br /> Naw Pun " Purnp,Ra lar6mant ":Pum Fta alr :1 Raise Wet)Ce.slr..
<br /> 'WELT.COT;sTAUC170N
<br /> Drilling Method X Mud Rolwy "Av Rotary "Auger ,CabLe Tool ;Puah Poird + Otrsr
<br /> Proposed Well Depih I00' h EIIcavaIIJA 12" _ v,d am6ua :;Open gNlom X Graval PaCWGra vol Size v�/8_In d'37 e4ar
<br /> Y conductor Gasing �in d;a r alar 1 GbnyUWdf Ceslr g Depth i s R
<br /> Well Castng D18m Eter 6" e1 Thicttnoss/GaugeiASTM Schsd SDF-21 SIC-61 'ZPloslic C 8I6!niee6 St6e1 '1 O!ner
<br /> Grout Seat Opp'h 9 ft :Neal Cement(Aa tb ba215-10 gai welarl v , 1-. _.....__.' K m,xf7 gaI wa!a!
<br /> Benio'.1m j20Y;Solidi) : Otrwt
<br /> (Grout Piaramf Metflod x Pumped Free Fell 7 RcKardani/Acce!erslor(name)
<br /> LECESj$i, lnmlallad By ..On"flat x Pump Con(racior _ O(h6r
<br /> —"--
<br /> `Concrete Pedoshl-DlrnaneIons:Widtn`It Largih It ThIC,( In "Christy boa 91ova Pips
<br /> PUMP --�-.., 3uomelsible"Turbiru Oitt<r HP PLOP Salk_,,,,___it Standing Water Laval t,
<br /> 1 HEREBY CERIIPY THAI'I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL RR DONE IN ACCORDANCE WITH SAN
<br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REaUiREt) LICENSE is
<br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL
<br /> WORKERS PENSAT)ON LAWS,
<br /> O DVANCE NOTICE REQUIREo FOR INSPECTIONS-PLEASE CALL(209)96 -76 7,y/
<br /> 5K3NED a HTITLE PFGSDIENf DATE l .____.-
<br /> �_..
<br /> i I
<br /> —tit
<br /> �` '�Tq f f 7►.,
<br /> sfv� t L _..
<br /> i
<br /> E?tl'RTMENT U 6 N L Y
<br /> � S
<br /> Apwic0 n ACoeDiod By_ _ �/2 Dale Area Employee lt:of wdw
<br /> Gtoul Inspection By Dale SPECIAL Weil Permit
<br /> Pump lnw6ctlon By Date 2 WAIVER RGCOIVAd
<br /> Sal Bed In ecIt. By ,_fi, Date _ Conslruateed'�Wrall Daplh_ _ _rt
<br /> CGrviMENTStdv -' --_zq . /� ytLf - 2ki ?TF!_D �S._L..Sx.k -
<br /> PE SC I Recelvod ChackXf Amount Date Parmiti Invoice A Wan IDA
<br /> Codes Into B osh RefiRiad Service Ra Vesl B
<br /> ENO ad-40 1,,� 7,, WELL PPAP PEAM.r'
<br /> Received T-idle Mar. 116. 2017 11 : 21AM No, 103,8 `Y" �'�J "'�
<br />
|