Laserfiche WebLink
1 ? <br /> _ WELL/PUMP PERMIT <br /> ON-R2P{a4DA�EPlRAOTaxrALMEAurDnArrtrwrr 1wEAerNr LT AVORM-9TooneaCAatlas-laag4eaagp <br /> CALL 209 963-70971=ow YdpECTtpK ptpt,PRO 1 YGM FROM DATIR IswaD <br /> JOE AOOr6as LsWK(77-yawl.-121"1" <br /> CAOaa"wr 1_640 UT71a>r Treer r-.a6� <br /> APN 2680e006 ■AaCal9Ra 7Y.w� r.... area7ror <br /> OWNER NAME San Ftwxbw PuW U®Was CmNrdVea Arw <br /> aalon PNoera 41 Ucam a <br /> Owsaa Aoa2aa 525 00 <br /> Golden pets Avenue CUYMTAMZP gAn Fnndaw,CA 94102 I <br /> CowntACTOR _HEW Drilling PHONE 950-322-2951 <br /> CONTRACTM Aocaus 1645 Weeks Street CTTWOTATEMp East Palo Apo,CA 94303 <br /> suacorMACToa <br /> Prow <br /> DuecommcToa Aooaess CnWSTATEMP <br /> Llcalwa a C-67 0 C-61 0 D-09 0 Other NuuaDt 904987 EsrtaATroN DATE 1MM020 <br /> 006128=WELL SANFLow:0 General MlneraUCollfonn Bacterls(4391)0 DlbomorJIIOMpropane(4392)0 Anenk(4393) <br /> [NRIAIeo Use 0 DomestidPdvsle 0 IntgattCNAgdudturol 0 IndusWal 0 Nater Ouelty Monitoring ■Dog SamPlhgrChsreaertrAkn <br /> 0 Public Wetar System <br /> It d1apmm eom owmr. r 6RG W— r <br /> TYPE OF Wait O New M9 0 Replacement Well 0 Well AllerelbNModllka0on 0 Other <br /> 0 Monitoring Nall(ol sof wale D Sal BoMg(s) s i1e ft, tl Geotedwdcal 2 a of b.&W <br /> 0 Out-Of-Service Wait O Out-OF•SsrAce Wag Reno" 0 Crou.Conneclon Repair <br /> 0 New Pump O Pump Replacement O Pump Repair 0 Raise Wal <br /> 7f)Oil.Lf <br /> Cow— <br /> Ring Method 0 Mud Rotary 0 Air Rotary ■Auger 0 Cable Tod 0 Push Point 0 Other <br /> Proposed Well Depth 50 it Excavation up M 810.1n diameter 0 Open Bottom 0 GnP.W Pock/G,vel Slza in diameter <br /> 0 Condudor Casing In diameter / Conductor Casing Depth—it <br /> Wall Casing Diameter_in TMcknes/Gaupe/ASTM Sched O Sled O Pleslic O Stainless Steel 0 <br /> Grout Deal Depth 50 it B Neal Cement(94Ib bsg/5-10 ga/valor) 0 Sand Cement as <br /> 0 Benlonlie(20%colds) O Other :�=_ P <br /> Grout Placement Method D Pumped 0 Free Fat 0 Other 0 Retardant/Accelerator(name) <br /> PEgEDAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedestal ODhnenslons:%Mdth it Le Ih It Thick In 0 Christy Box 0 Biwa Pipe <br /> liputip 0 Submersible Turbine 0 Other HP Pump Set it N/alwlevel R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH DAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE 15 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIWJM 48 HOUR f DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> SI9NE0 TITLE DATE <br /> ti <br /> _�- FIV�T <br /> 2019 <br /> TITH I <br /> r�My <br /> 0 �1R MENT UJIBE qPNLY <br /> Mph+Accepted By DateMaErtlplOyae IDS <br /> (;soul InspeGlon By Date 0 PEDAL well Permit <br /> Pring InapacDm By Dela 0 WANER Received <br /> 61,61 Boring Invecdon Sy `dJeP�.�t-2 7: Dae6n—/(?—fY C...b tad War Depth R <br /> COMMENTS R <br /> PE &Cd I ChaeM/1 ATnount Dae aarNe klvOeea f Well Di <br /> bb _1110 Nava" <br /> M 00 rarteee 4rt4= /9�g M.L ser P.9er <br />