Laserfiche WebLink
WELL/PUMP PERMIT <br /> Of S.LNCoiwrvE%�iRowkNTALAF.AmuDEP.,RT.U61,T 60E,S•r3twNSTREEt-STOCKTONCA95M-(M)4OW3420 <br /> :VON-RET,C!V DABLE P£R)!I? EXPIRES 1 YE'.AR FRO\l DAT£ISSUED <br /> X3779 ✓�9C 70- A �� �C o <br /> 34BADORI:S.S �----�— <br /> tT U <br /> CROSSS'rREtT 1 I _ APV_ 0/� PARCEELLSIZE <br /> OWNER NA,IE /�/� ��///�� _` Pl1a,L �// ��7/ ✓/V <br /> OH-ERAoDRm _`� ['=,r CiTirifti TF/ZIP _�(y <br /> Cat tRACtON Id 106 7C/� Pjto7,E <br /> CC)N7A,ClOR ADDRESS fv 6 <br /> SUBCONTRACTOR PRo,E <br /> 1'UBCO!�TY,CTOR ADDRESS___ _ __ _ 2 CitYlStATEILP_ ______ _/��,—�•— l <br /> LiCLNsr ❑C-37 -6) D 17-09 Wll., Y I /_ \t fiBER 5 7 Es ntrLtrlo,'D,TE 3 �!-� t <br /> GEasR.,PHit.AL I:vEOAst.,110N: Coordinates )(_--._ —___ __ Tot,nship__ Range Section— <br /> i.1TENOLD USE "cPrisat,: 0 irrigation Aimcultural ❑industrial Ei Wat-rQuzbty Mmitering 0 Sc-.rapting Cbaractttvtizah. t <br /> Public Water System ----_--- -- --- i <br /> Ifd&ew–w fres&. :! ii'.cy Sp•_r.:No,.. Cavzxcc-%'—,rI'hres Num.+» <br /> Tsrc OF%oAK G 1zw W'cil C Replai"-meat WcU C Well Al.aatimtmeWfiicnion C Test Mc C Oder__ —. <br /> C Monitoring Weii(s) av a<incirs p Soil Borkngi,)_— `cmv•.tt�toa, G 6c tuchaiwl e,xortxeay <br /> G Well Desnuction G Out-Of-Ser ice 15'61 a Om-OFx-nica Well Rcuc%al <br /> G\est Rcstaceatcrf G Pamp Reay G Crossranawrion Re-pair <br /> WELLCON>'IRLCtiO\ i <br /> DrMkg Methtod G Mud Roux,, G Air Roary O Anger C Cable Taos C Push Pon G Other <br /> Proposed we" Depth _P Excavation in diameter D Open Bottom G Gravel Pack,Gravel Site in diameter <br /> 0Cenduet"Cw419indianneler f Conductor Casing Depth _R <br /> Wall Casing Diarn-atcr_iii ThicknewQuIqc'ASTM Sched — C Sxzl C Plastic G Siaiole=r Sice! 0 Other <br /> Grout Seai D:pclt it (3\cat Cement r94 tb bag:'i ffign!unaof C Sand C.'Tnx.: scrh,iaiv:?gal waxr <br /> G SentoWic 12t)'.';solids) G\lasmfaaurer Sps >ol ds_",; Nmrc_ G Spas or eiL i:.'5-w s Submine3 <br /> Groat Plseeoeat Net6ed C F •d C Frcc Fall C Otbzr_ C RLzIarJ nt:Accctusws(tGirtc) _ t <br /> i PEDFST.v. Installed ON, C miller ❑Dump Contractor O Other <br /> C Concrete Pedo" Dimensions: Width_fl Length_ft Thick in G Christy Hos G Stere Pipe <br /> PL'31P S:bmmibic i7 i'urbiir L70thcr_ _ Hi-3-5— PUMPS^i tt SundingWxrLe:cl_ ft <br /> WLLL DL5TRLCttON 0 Open Bottom D Gravel Peck Cl L'ncas;d G(Flier ---- ' <br /> Welt Diameter_in Toto Depth__A DgRh to A,=er_____,h G Casfug w tc Pcrftiratzd frnm ft 10---ft f <br /> ScaFing Materril G Neat Cenir st/9416 bag.3-ing d roasr) O Satid Ccium TACT'altar 7 ger oxer G aemonhe Pal" 3 <br /> G Hcatomw(29"e"abets) G Manufactuvr Spat`.a solids_— :;, tame C Specs on Fil_ G Spcc Subnuuzd <br /> Placement Method G Pumped ❑Free Fail G Other <br /> G Com tett with ldusbrwm Cao _ _ft below grade G Com*-,,a io Ecisting Surface Pad _Ji <br /> HEREBY CERTIFY THAT i RAVE PREPARED THIS APPI1CATiON.AND TfIAT THE WORK MILL BE DOVE.LV ACCORDANCE WITH S.A.\ <br /> JOAQUEV COUNTY ORDIe V STATE LAW'S,A\T)RULES ANI!REGULATIONS. I ALSO CERTIFY-THAT Afy REQUIRED LICENSE IS <br /> CURREVY AND. CALIFORNIA CONTRACTORS STATE LICENSE HOARD AND THAT I AM IN COMPLIANCE ATM ALL <br /> SWALD �/CYC/✓///X�UV.m /G DATE S 46 <br /> RE yMF <br /> cE��or <br /> N SEP 0?42 <br /> E TOR NMN y 0 <br /> co <br /> �EPgR MFNT <br /> / DePARnIEN-T U oNs r <br /> AppliCetiODAWeptedBr C� --� DNe 0,;O ,tea c G1 EtapioyeelM 11Z _.. <br /> Gr--X Inspx7ior By Dain 0 SPECIAL Well Permtl <br /> Pomp Inspection By �\'J lQ c t- 'L y�ye �Q I 1� Q WANNER Received <br /> Destruction Inspection By Data Constructed Well Depth it <br /> COM.KEN fS <br /> PE SC Received Amonot Resettled <br /> Date Penult! # Invoice# wtoHIMt <br /> Codes Info <br /> 6 j 7 <br /> I <br /> EFiD 43-M-006 WEB &'e.:Pervtit ane D gra or kA <br /> 9:t 12111)7 <br />