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WELL/PUMP PERMIT <br /> SAN JOAGUIN COMNrr ENNRONrASNTAL HEALTH DePARTMeNT 1666 EAST HALrLTom AvrNve-STOCKTON CA 66206-6222(209)666-3420 <br /> NON-REFUNDABLE PERMIT wwwoloov.orialelld EXPIRES 1 YEAR FROM DATE ISSUED <br /> Mountain House ratelaij c„yt„ Trac CA 95391 <br /> Joe ADor _ <br /> Caoss SrauT AIN 1264-66-030 FAeeu Shia®LAID Ues APPLICATM 6 <br /> ` AlbaASOnf C 00109 PHONE 20&831 4801 G <br /> OwlveR Name _ ---- <br /> DtlanRAooesaa2 0 Pffkrfnar oulwvd --�,- ctTyn,A,ea„ 13011,0, ID 83706 <br /> • _ vHow X25 BA9 8970 <br /> coNrlucroll Ca6c61df DON ------____-- <br /> COrmtAcroaAotvhrss 1841 halifnge Drive —� (Concord,CA,94520 <br /> SUecolerRAcrvlvCoNavLTANr EN EO•Inc=ratfd _. ---_� --- Pw" 92:-888-x)00 I <br /> SUDCON tlACTOR/COMIlULT hT AODRsss 1010 Crow Canyon Placa.STL 250 CflY1$TAler1W SB Ramon, CA 94598'1 <br /> LAxWr \C.57 C-61 0.09 Other NUMasa to 8316 ETrrIIA rr,N OA rs _ _ __ <br /> BILLOW PARTY: OwN6R CONTRACTOR �9U9rCM0aAGrOR/C*%*W later <br /> DoAttsTrc WRL SAMPLING. Gerrard Mvroral/Cotlform BDclons(4]91) Dlbromochloropropene(4392) Arsenl0(4393) <br /> �j DomeMuPmab ImgalrorVAgdcul ural Industrial \Water Duality Morxtowl; Sal SempenyrharerTertarvn'� <br /> Pu01tc WRNr Systam <br /> 11 oMwd.Om 0— W.I.,9W.n,N.r•V G•nl«r N«..r Pr n^r P,rn« <br /> Tyn Or WORK New Wra Replacement Well Well N(eraliontModdKalion Other <br /> MonnonngWea(s) 6orwa111 50d00nng(-sl \GertecnnKal_TT1 _ a''-' <br /> put-Of-s"cs Well Out-0T-SorvKe WAIT Penewrd Gross-Gonnerovn Pepav <br /> New PLr p Pump Replacement __-Pump Rapaat <br /> FMLL COMTRVCTION Hollow Starr, <br /> DriUng Method MW Rot Ax Rotary Auge Cable Tool Push Point Other <br /> Proposed Well Depth, R Escavauon In diameter Open Bottom GevN PaUUGrrm Site_ n yare+d <br /> CondUCror Caning In diameter / Conductor Casing Depth it <br /> jWell Casing Diameter in TNCkne5s/Gauge1ASTM Stied Steel Plastic Slawlesr Steel OTer <br /> i I _ <br /> Grout Seal Depth M M Neat Cement(54 to Oag15-10 gal wafer) Sand Cement j sjri ;at-rater <br /> 0entonne(20%solids) Other <br /> Grout Placement Method>ewnped Free Fail Other Retardant/Atceleratcr frame) <br /> PfMSTAL NstalMd By -Dnier Pump Contractor Other - <br /> ll Concrete Pedestal Dimensions,Width it Length it ThICk in Chnary I:ca Stove Plpa <br /> Puar Submembie Turbine Other HP Pump Set 0.1 Sta•,Grc,ha+er _eve) t <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORCANCE vlrT-H SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE ,.AWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED uCEsSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPUANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> ' •:Y 10 <br /> NOT 1,_E REC'1jtRF.O FOR!P�I'{,PyF''TION;-PLEASE:ALI ;" <br /> SscrEo TITLEDATE ?c' <br /> 1 <br /> - IF <br /> � f _ I I bFP?8 2020 <br /> YR p USN CO <br /> — — A �EPgRTM L <br /> ENT <br /> 1 _ <br /> DEPARTMENT USE ONLY <br /> Application Accepted By prts z Atetl� Employee 101 <br /> Grow InapetLon By _ oale lli. Z J iJ SPECIAL Well Pennit <br /> Pump Mapsdwn By Dab WAIVER Received <br /> Sob BOMB Inspection By __�, D Is _ _ Construct d Wall Dspth R <br /> COMMENT11i �) he�-IL�E ti 1`� �') L r <br /> ,c Y�uLt ►w�tti c1cL\ c " rD, <br /> _T Chick v Amofall Invoke 6 Wall IDII <br /> Codes Info Cash Ramlltsdu 6lervks Re set f _ <br /> E�O.Iq NI1 R0lp ''ll W[,LL,PUMP PERMIT <br />