Laserfiche WebLink
' WELLIPUMP PERMIT <br />1 SAN Jw mm Commr ENIIRommoaAL Hm-rm D ePA;nww 1868 EAST HAZ ELTON AVEIAIP.-SWMTDN CA952M ZM (289) 488-3428 <br />J NON-REFUNDABLE PERMIT mmm-sigoy.orglohd EXPIRES 1 YEAR FROM DATE L%suED <br />E•^' c JOS AW;M.Ad CFrVrAP A ", CIO <br />m <br />QIJ'%�0 C'87A7-T II/ {'L' 1►^ Sty0ef APN PARCEI S[M ID I•( LAUSE APKXATmu# o <br />OWNERNAMe onln <br />°/P�IION� <br />""�` AOO°£� Cr1YtsTATFJZF <br />COMRACTOR <br />P. <br />ComRACTM ADw�ss S =� Cm,>SA,._2..1.; C►g _ <br />LICENSE C G-57 X-61 C D-09 <br />BILLING PAKTY_ -1 OWNER <br />CRYlSTATFylZr <br />11 Other NumBERM!"LIA 1S EJtPi .. <br />O Si8CONTRACTpq/CowwL7FANT <br />DONesncWELL SA�IVLwe. u Mmwal/Cofifmm Bacteria (4391) u DbwnoaA-plDMm (4392) U APiew (4393) <br />mrrean <br />)UW uomesbdPlNab2 J krigatiadAgt(aelhelal C Irt�strial ❑ Water a Y Mon torvg n Soi San P1irglChharadaization <br />n PubGC water System`_ <br />x ®aaM tom Omer vvaeter syslern Nana - -- -- oonhd Nano or Phan Mn10Q <br />r vTw OF wnorr I I Nle.. wen -- — <br />I I Mona Drvng Wefl(sL 1i of wefts I Sal B.'k g(s) N aFWOM I Geate ch is ad d <br />I I Out-OpFS�ervice Ou40f�Savice Well Ptenewwl I I Crossl,mnection Repair <br />I I New Prmep ,PlaCerrllylL 1 1 <br />VMRA^P R�r i t <br />Rase Well Casing <br />_ . <br />Uri®ing Method n Mud RMz,,y I Air Rolary I Aurpr I I Cable Tod I I Push Point I I Other <br />Proposed Wali Depth R Exraratlort in diameter 7 Open Bottarn O Gravel PacWGraM Size in dim <br />❑ CondLlCtar Ca5iFQ _ _ m doamter / Condudnr Cagy Depth ft <br />Web Casing Dameler _ M T­hidQWllrllq&AsiM Scree _ StM ❑ PWSbC o SUmdess Slee) C otng <br />Grout seal Depti1 ft n Neat Carterd (94 tib bag5-10 gad water) n Sand Cernerrt_ <br />sack morf7 water <br />I I Bentonite C20%Sni1G3) I Oftler <br />tlrotrt PtaCCtLLe7rt lldfwd Pumped 13 Free Fa0 7 011ier ❑ Retardant 1 Acc elefator (rvrrte) <br />P®ESTAL hLsta/ed BY ❑ Dnler G Pump Contractor 6 Other <br />I I Concrete Pedestal I Dlroens:ovs- ylRdye R Length R TN* m I I Christy Be. I Steve Pipe <br />.� toreez I: Turbine n other 't- HP Pemq, see r fl n St.rrxr., ware. c <br />1 HEREBY CERTIFY THAT I HAVE PREP e <br />AR® THIS APPLICATION AND THAT THE WORK WIL1. BE DONE IN ACCORDANCE W(iH SAN <br />JOAOM COUNTY ORDINANCES. STATE LAW,, AND RALES AND REGULATIONS. 1 ALSO CERTIFY THAT WIT REQUIRED LICENM IS <br />CURRENT AND ACTIVE WITH THE CALIFORM CONIRACTDRS STATE LICENSE BOARD AND THAT 1 M w COWPI. F= WITH ALL <br />WORKMtS COMPENSATION LAWS <br />lMUM ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />sem TITLE (; L+2 iM 4-O e_ DATE ,"- 2 / - ft Z / <br />j DEPARTMENT USE ONLY <br />APPficaton AGcepted By � L L _ Date <br />Area - Employee Ib#�_- <br />Grout Inspection By Date ❑ SPECIAL Well Permit <br />Pump Inspection By Date�� � l ❑ WAIVER Received <br />Sal B0609 btspecMm By Date Constructed Web Depth (} <br />COMMENTS <br />iR'7ir�'1•I'1_I'I -- — <br />qC NjFNT <br />F/ QED <br />6102021 <br />QU/N coU <br />0 PA,, M4 L y <br />