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Nov 15 00 12;47a p.2 <br /> I <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN CcuriTV ENVIRONMENTAL HEALTH DEPARTMENT law EAST HAzELTON AVENUE-STOCKTON CA 95205 -(209)466.3420 <br /> NON-REFUNDABLE PERMIT CALL 2D9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> rp <br /> Joe ADDRESS 9053 E St Rt 4 Hwy — CITdhP:Stockton __ D <br /> aa �] v <br /> CROSS S7REEr Kaiser R U APN 1 �n 13 0 cc 1 r1 J 0 7 PARCEL SIZE I LAND USE APPLICATON 611 a <br /> OViNERNAME Paul M Sanquinetti PHor209-466-0672. <br /> OWNER A DREsc 7 6 7 7 E Hwy 4 c T,,sTATE,z,;S t o c k t on, C A 95215 <br /> CONTRACTOR Purviance millers , Inc . _ PHONE?09-887-3554 <br /> CONTRACTOR ADORES?• 0- H OX 64 CITYISTATFRtr Linden, CA 95236 <br /> SUBCONTRACTOR n/a PRONE <br /> SUBCONTRACTOR ADDRESS CIIVSTATEIZIP <br /> LICENSE x C-57 C-61 L a09 a Othe• NUMBER Expili N DATE <br /> GEOGRAPHICAL INFORMATION: CooMln,",es X Y Township_ Range Section_ <br /> INTENDED L13E Domes5dPrivate rigationlAgria,Rrcal C Industrial L Wal O.,alltq Mon Goring ❑Soil SOrnptnlCharacleraalion <br /> PuDlio Water System O <br /> CJ <br /> Ir EiRernm Yom Owns. --VV ai 5y5 ern enw „o erre or ore u r Y — <br /> TY?EOF WORK )(New Well I-Replacement Well : Well AlteratiorJModi6catlon L Other': —i CT <br /> al on 69nngs chQar springs r C �- <br /> T Monitoring V'ell(s) #ntwetls Soil Bo rigs) r Geotenical <br /> n Out-Of-Service Well i Out-Of-Serw�---Well Renewal r- cross'Connection Repair r5 3 �a <br /> 1 New Pump Parrp Replacement J Pump Repair C Raise Well Casing <br /> !WELL CONSTRUCTION <br /> Drilling Method Mui r' -f Air Rolary J Auger We Tool _ Push Point u Other -'S Ql <br /> Proposed Web Depthy� It E,ravation ��_in diameter /Open Bottom �D Gravel Pack/Gravel Size in diarnel CCD <br /> Ll Conductor Casing NI-q— in d am ler I Card,—, -,sing Depth ft <br /> Well Casing Diamoter.�_ in ThCxnPssJGaupeJASTV Shed � 94 Steel `J Plastic r Stainless Steel Other e ID <br /> i <br /> Grout Seal Depth 2�tt J Neat Cement(941b bag9ifOgot water) do Sand Cement 10•5 sack mirR gal water a CX <br /> n Ben,,,.,,. 20%so9ds) I Other y C) CE) — p <br /> Grout Placement Method !Pumped -Free Fall L Other !7 Retardant IAccelerator(name) <br /> PEDESTAL Irwtalled By Driller 3 Pump Contra Uor 71 Other _ <br /> '�J Concrete Pedestal'_Dimensions:Width ft Length R Thick in a Christy Boz ❑Stove Pipe <br /> PUMD v Submersible. Turbine -i Other HP Pu!no Set It Sanding Water Level ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPA ED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN =r Q <br /> QU1N COUNTY ORDINAIl r ESTATE+ S, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRcD LICENSE !S C� <br /> P E R EENT AND ACTIVE VR" ALN R A CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> "IT <br /> COMPENSATION LAI' <br /> MI M 2 ji R VANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-7697 <br /> ran it m6 1,71 TnixCorporate Secretamp 4 /17/15 <br /> ork bei <br /> by Erwin <br /> I <br /> 1 I <br /> I <br /> RF4 F�Nr <br /> JA <br /> P{�?® <br /> I 20 <br /> F �04,Wy COU 1� <br /> �aEAtR M <br /> DEPARTIMI ENT U E O LY <br /> L <br /> Application Accepted Date Area ( 1 Employee IDA rrC� <br /> Grout Inspection 9 Data L] SPECIAL Well Perrnit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Bodng Inspection By Date Constructed Well Depth_ ft <br /> COMMENTS. ( <br /> 11/d <br /> PE SC Received Check#f Amount Date Perrnit! Invoice# W.11 ID# <br /> Codes Info B Cash Remitted Service Request 4 <br /> X31 BSc-- '3 <br /> END 4396 <br /> V&-LL fPU MF PERFAIT <br /> 4!]Mt] <br /> Received Time Apr, 17, 2015 5: 14PM No. 8545 <br />