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r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 6232(209)468.3420 <br /> NOr N-REFUNMABLE PERWT W*w OV.O 19hd EXPIRES 1 YEAR,FROM DATE ISSUED <br /> �Joe Aamssy ��T viciy CrryizIP Plc cG t1 '� <br /> r�, <br /> CROSS STRt _4� C) APN Q O t V PARCEL S�r� -L.-USE ARx;cATlat 3 <br /> 1OVIIN P NAME �� k i����vi erS —c�'�' PH q 7S;-_ c(s — 63,3qs; <br /> �{)PR:'ER ADOF.FSS T K/;vi f Club, / V <br /> ►J f'1bt2. CCtY1STAT'JbF t{� L✓ n,S hay Cft 157 <br /> fl� �:va. sdl �jr?Its <br /> PxottE dot X16 -7 <br /> �,• �. <br /> CONT4PCTOR AOOREss mt <br /> _1 � YY� s u rs! ; cSTAr<2m ' h(A <br /> SUHCOP TRACTGR1COtLSULTAUT -_ t1.,T l�:a{h/w r'7 GPi1T>;G�tLtJ, Cc! :..r PJHONE '�'�i CH{,-G�t t1 <br /> SUECCU RACTMCONSULTANT ADDRESS 1110 h L)-P vI P•tT /T11( CLTY?STATvz P CG (C_J199 L�S' �Y'l I•U J 1 <br /> LICENSE ,C•S Chit D-o Other NJrt3E 7d rJr;e4_ ExPIRATION DATE O <br /> BILLING PARTY. OWNER CONTRACTOR USCONiRACTORICONSULTANT <br /> DOUESTIC WELL SANPUNG: General WmeraVColi'crrn Bacteria(4391) Dibromochtoroplopene(4392) Arsenic(43937) t <br /> INTcHGEm U5F DomevriPmetne Inngazon'Ag iwfttsal _ Industrial Nater QuaYty Mon;Aonng /So Samp1inWTAwcterMsfwr } <br /> Rt.6ldc Vrater Sys:em i <br /> l:.S�k�-C+,".YT Or:,er. 'vV�'tr sY9^'x'22me Lonti-N�ntl ar Pt;vfe Nrs+Oe !I <br /> TYPE OF W ORti New 1reE Replacement 4`ie9 ,Via AlutraaonlModdiication Otter <br /> Monitoring`Nell{s) A Of vr�s Sob Bonnilis) S axoc..P Geetedvvca{_tea aeo�nye <br /> JJJ\\\ 1 <br /> Cut-O<-Service 1','e[f Qui-DLSawvice Well Renewal Cress�'o median RapW � <br /> New Pump - Rwnn Replacement Pump Repair --Raise Well Casing i <br /> 1}HELL CONSTRUCTION <br /> 10rdling Method -Mud Ratary Atir Rctary 3(Auger Cable Tool Push Point Other ` <br /> Proposed Well Depth_. Excavation in diainelar - Open Bottom Gravel ParlUGravel S¢.e In diameter( <br /> Conductor Casing in diameter i Conductor Casing Dept, It A� <br /> j Wetl Casing Diameter in Thi$otessrGauge.ASTM Scired Steel Plastic Stainless Seel GTher <br /> Grout Seat tkpth _S XNeal Cement e9d ih 6ay^5-FO gat w3'br9 Sand Camera:solids! <br /> Be —sr--k^x?gat water] <br /> markte(20% Dl�hzr <br /> Loutpuzamam:]A.thod Pumped -Free FaR XOlher�'t tt Mgr -Ro-:arifa�t;?cceieretor tneme) i 0�� <br /> IPEOEsrAL Installed By Dae` Pump Contractor 1, Ot1w O <br /> Concrete Pedestal Dimensioas:4Vdth_R Length tr Thick in :Christy Bax Stove Pipe r�//,JO 44Q <br /> L---, Submersible 7urtem Oulu HF Pump Set R Siandmg tVater Level 'Y 'Q <br /> I HEREBY CERTIFY THAT f HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WRH SAN Tjty"44 �O/ ,.•Y�1 <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL q,QNT,q�NjY <br /> WORKERS COMPENSATION LAWS. <br /> 1:4UNq HOUR AC1S'A 7iCE REQUIRED FC�INSPECTIONS-PLEASE CALL(209)95JJ3-7697 <br /> Std TITLE �o DATE <br /> I isi 1 1 if i1 ' I 1 ! 1i1filill <br /> I !Z11111 Iii i4 ( lit if ii <br /> 21 ff it li l it <br /> 7 11 l I ) <br /> t l <br /> ! r I 1 11 1111 ! <br /> I <br /> t2Uj <br /> 1 <br /> l 1 1If. <br /> L—11 <br /> I ; <br /> i 1 <br /> I ) s s <br /> 1 I I i <br /> 'sl 1 li <br /> DEPARTMENT U E ONLY <br /> Application Accepted By Date Q Q Area <br /> CCS Employee IG9 <br /> Grout inspection By Dale SPECIAL�A�\ SPECIAL Niell Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth R <br /> COMMENTS <br /> PE SC RecOved Checwl y Amount j .� <br /> peru' <br /> Codes Info Cash ' Remitted ate i ge R st# Ttevoi<eS Well Ili <br /> 3'7 ' <br /> - gbh JyJ/� 115�3�s1� <br />