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WELLIPUMP PERMIT <br />SAn JOAQM CDDTrnr ENI PMORRAL HEWITI DEPAMWW 1868 Easy HAZMTDN Avmm Smum* CA 96M RN) 46LUM <br />NON-REFUNDABLE PsmT www_sjgoy.orWehd EXPIRES t YEAR FROM DATE ISSUED <br />Job ADDRESS o J (P / / 111 /'1 d p prv/Zp -5CJ ! 0A �: j 3 z o <br />CxossSim:t. C'11 i API PARCELSty t C LAND USEAPrLN:ATMii o <br />Owrt£x NAME P. <br />OWNMADORE.R8 f-eF)`IR A CnylSrATFJZr <br />C -AD- :3. k) . t� )� l%`i CmlSfw7E{LP� <br />SI(ti .0KTRAcrnruC0K510_TAKr <br />7RACTORFCONMR-Tmu ADDRgS _ <br />0 C-57 90-61 C D -W <br />PARTY: 7 OWNM <br />CnY)STA1,TVZP <br />0 Oaten WmB8t%05 ^ Y 1 EWatATpN <br />0 CONTRACIDR 0 SUBCO"TAOCTORICOMSULTAUT <br />'OIL'c Wel SAl�t1JC U GertClai MirleraUC ofifarrn Bacteria (4391 } U QltifOfllOG11QIDp(ppBliP (4 92} J ArserRc (ai9s} <br />luE 7 U16gationlAgriadhiral C Indlstrel ❑ Water Oua6ty tlanibrurg 0 Soi Sa�tion <br />n Pvpfc Wats Sy5[an <br />adwe�r eom o.�rr. wxx N� Nrnw -- - c:onmtt wne a enai. Kunty <br />f1mE O+F Worar 1 1 iVevr YYe9 I WrJ i Wei AkerationilAodfirafim I (llfwr <br />II MmWming We(I(s)__BOIw@DS I Sal Borbi s) sdbmags 1 Gectechrkw 9°rb�&.Ds <br />I I Out-0FServire Well I I Ou"AServioe Wed] Rene" 11 Cross_Connerjim Rem"v <br />Nr -w I I mann I I PUmp Repar 11 Raise We0 Casky <br />Wal N.OKSiRUCf1ON <br />DHlling Method 11 Mud Rotary I Air Rotary I Auger I I Cable Tool I I Push Porto I I Other <br />Proposed Wag Depth ft Excavation in diameter 7 Open Bottom 0 Gravel Pa&JGravCI Ste in diameter <br />0 COMUCW Casag In dWrleter / Condudar Casing Depth ft <br />Well C—ng Dtarle{er _ in Thid ASTM Sdred :3 Steel 0 Plastic 0 Stars Steel L Other <br />Grout Seal Depth ft n Need Cement (94 16 �a.7o gat water) n Sand Cernerd Sack mDd7 gal water <br />I I Bentonite, (20% SOWS) I OUrl <br />( rWlt PbCerDent Method 0 Prury>ed 0 Free F 7 Other 0 RetardantI Accelerator (name) <br />P®G4TAL Installed BY 0 Driller Pump I r 0 Other <br />I I Pedestal I Wmeruio� Ytrdth ft Length ftThidr in Christy Boz I Stove Pipe <br />1= bmers>blac Turbine 0 Other HP Pump Set E Standvg Wats Levei R� <br />.vr.+ncv rri<a N'rL.AIMIN AMU THAT THE WORK WILL 66 DONE IN ACCORDANCE VWM SAN <br />JOAQUl" COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATKM& 1 ALSO CERTIFY THAT NIT REQUIRED LICum Is <br />CURRENT AND ACTIVE WITH THE CALWORN1A COHIRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WOWERS COMPENSATION LAWS_ <br />P�qlmum.�ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DATE <br />�7 <br />DEPARTMENT USE ONLY <br />�t <br />Appbcatlon Accepted By 1'� !- Ey . Area_q ' (% Em l� <br />Pbl� IDU <br />Grout Inspedion By Date O SPECIAL Well Permit <br />Pu.v Inspection By Date 1 J I Z.. 2Z CI WAivER Received <br />COMMENTS y� a f V f m i J 7 4Ja a? �' Date A E ( O DCC_ P �an�n Q ft <br />ffim8 <br />EMD� MIM'L <br />EENT <br />QED <br />102021 <br />UIN <br />PAR Ml COUNTY <br />ANT <br />