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WELL/PUMP PERMIT <br /> S.t%JO:\QtLN COUNTY ENVUtONbIENTAL REALIff DEP.MT.MkNr 500 E Wy M.ur•STRCEf-STOCKTON CA 95292-(•M 468-3126 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> 7'"AtIDRL,S �J <br /> CrrvfCaF__ - > <br /> YCFL <br /> CROS STREET �.; SIZE <br /> _ <br /> OLYVER N.S\IE <br /> se <br /> OWIERADDRESS _Q✓-�i,//�/"r! ` � 1//V UVB CfTYiST:\TE(L!P �f nom]' Q�Q 9 <br /> CD%MACTOR •r'✓"✓G Gtr ��//2/w9 /�PROAE ^' r /!�J/V� / //�]� L -7 <br /> C4D%I3 LCIM ADnRESS �• 0W 1 ^6 Ctn7SrATFSL(P ✓ t �'/�t/� C•!'T �2,J Lr <br /> St+ECDSTRALTOR PW�� <br /> SUNCO\TRACTOR ADDRESS _ CIrv/STATE(/JT _ <br /> ).IIE-st: 13 C-57 K-61 017-09 O Other Nt /"GW5t 11Mx%TIO\D.\TE q O 31 2-2- 1 <br /> GE0r.R%rHtCtLI.%FOA%I.ttYY.: Ceordisates V. _ V _ TuRnship Range Sectlen. <br /> 11Tx'.ALDL'SE c:Pritar: 0 irrigation Agnculwat ❑toduiariat Q WaterQuathy MiaS;toring 0.%"l SnrnpfioGCltaractsPeat,rm <br /> 13 Public <br /> Ifdifci:^j <br /> TalE OF RORPbcra vu��+_r /"�r/ �� <br /> 3C Ci I wail t teplacoment 9Ven 17 Well Altemiow-Modificnion O Test Hole E3 Ocher_ E v EI SAI <br /> EI3Mcoiw1ngWell(s)^_ 'x'«w.�ts OSoil Bari+> ). «�bc•15dmg 13Gcwmhn;celD <br /> 3 W-cil <br /> Dcgnw Ou;-ofS:-ties bvo17 Ow-Of_Ssic:Wal Reon9 <br /> u!ww1. PtmReplacement O Pty . ir C ms -Cnxin Repair <br /> SEP <br /> 18 <br /> 2020 <br /> Iht83Rg Metbod 0 Mud Rotary O Air Roary Q Auger 0 Cable Tool O Psh Point 0 Other AA nr.i q Q UI <br /> Proposed WtH Depth _R Excavation in diwacter O Open Bonom ❑Gtavet Pack i Gravel Site-in the;Q <br /> N COUNTY <br /> 0 CpndW0r Ca,fng ;n(hameter ! Conductor Casing Depth R HE ME <br /> Well Casing Diameter__;e Thickne WGaugc.•1STM Schell E3Stcal O P Pastic Q Sta;atees Steel ❑Other DEPARTMENT <br /> Grout Seat Depth it I3\cat Cctannt r91 fe bag:S-!(iga):.are'i ❑S:tcd C:a izz: sackmir;7 gal Rater <br /> ❑9ewcaite ebF;solids) d Manufua rer Spec soP d `:eax M Spa>on Fite rr 5nwss Submi=d I <br /> Grwt PlaeMeat Metbd O Ra EiFrx F.W ❑Giber 0R0ard=a.,Acccit:rator(nam.) <br /> PEDFSTAL taataNed Btr CI 9riltcr I3 Pttmp Contractor ❑ODtcr_ -,___-- _ —,- <br /> ❑Coacrde Pedestal Dimensions: Width_ft length_ti Thick L-t Christ•Boz o Stave <br /> Pt:?IP sbmetsible (3 FurNne ❑Other Ki' Pttt�Sq to Sttndial Wa:.TLe.cl. II <br /> WELL DI.STKUCTfhs 0 Opal Bonom Q Gravel Pack Z31 ,w Q Other e <br /> Weil Diatnwr_in Total Depth A Depth to Water-----A 0 Casino to be Perforatai from _k to— ft f <br /> al"Material ❑:aCa%--n(w 1b bog S-Trw!amer) L7 Sand Cc=nt wa.-at-i? <br /> LBrntnoic(93solids) Q 1aufzrr Spry��fOlds wa * GSp�ksaOARartielcP-cfe <br /> _ i]& <br /> ;.T"Subn <br /> lac"mt Method ❑Puntd 0 Frn:Fall E3 Other <br /> j <br /> __ El Complete x ith Musbtoom Cap ft bciwt grade O Compie:e w Existing Surfuc Pad 1 <br /> !HEREBY CEWFIFY THAT I HAVEPREPARED THIS APPLICATION AND TART THE WORT:AII.L BE DONE IN ACCORDAtiCE WITH S-A_ti <br /> JOAQ`ES COUNTY ORDINANC TF, W.S.A4D RULES AND RECUL411O.N& I ALSO CERTIFY THAT 31Y REQUIRED LICENSE IS <br /> CURRENT AND TV 17 A CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN CON PI.IA:\CE WITH ALL <br /> WOBKIRS COMP <br /> SIGNED L(/ &1 L <br /> DATE <br /> � t y <br /> i <br /> i <br /> l <br /> i <br /> DEPARI'3 i T:£ Y <br /> O <br /> Appliat;atA,cwrptedayy' ' - 1»e Oord % Ernm,,.im I r•_ <br /> GrSsti Tns)sut;an 8}' - Gate 0 SPECuL Well Permit <br /> Pomp Inspection fl a � �. Date LA 1 Vvw- Q WAIv-ERReeeived <br /> Destruction Inspection By ---. _ Date. tonstruaW Well DWyth_ ft <br /> COMME1�iTS <br /> PE SC ReodreQc4rd <br /> Codes info AffAce Pe Ra >e IRv rloe r@ Wed w# <br /> so 7 <br /> MID 43-021106 WEB w2Lt Per w r and EkTtarar d x <br /> 9;111 ti%aT <br />