Laserfiche WebLink
WELUPUMP PERMIT Ivy qu-�72 ' 981$ <br /> Sax JOAWeI Couxtt ENVROx1IEMAL He•,Tx DEPaRTsm,r 1968 EASTHsm_ran AYBaIE-STgcrrmx CA 96209-(209)469-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 9537697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> J.ADurtEss 0283)3 SMacArf ur Dr✓ I:IMZ>PTi✓acv cry 9'Sa�� a <br /> CaossSmEEr / �^' a APN PAacELSrg LAtm IISEAwuca,mrri m <br /> OWNEaNAME (�uf�/rynn� QYc1�n.r T' SZt l f K Kh � <br /> PrrE <br /> Ovm.An .,pill000 JGr/,T9 irejea-rol W4�/ CITYISTATE2R f vac✓�� ��� - <br /> CoNTaAcTaT Z�a.t1S u47Eev writ rPcct�wY d[I. ,��c. Prler� 316 is c� <br /> CoxmaeTae AoacEss3k'?k CQttil hr Ct1JW aw/le 03 CMISYATERm <br /> m <br /> SuscoxncTaa (annn RZ S' / �PxwZE PI'S/ oW <br /> Sux <br /> 9camacT0n AnaRE55 Cninds1 IFA.v N <br /> 1� LICENSE ID57 a C-61 L D-09 ,Olhastee.®er K41 A 4 EIWRATmx DATE O 3 110 f, - <br /> i GEocaa W)U_lxro 11014: CoordinatesX Y Townadip— Range_ Section_ <br /> INTExioE sE Damesfilmiale L Im en/ ml i�irldu n Quardy Mavleing L Soil SamptinglCharactarizaten <br /> �P.b is Wale,system g f4� 6►J a- V iii Lit.ry W S <br /> If aMemM sem Omer v�wS --`- GTedNa �r�ear <br /> TYPE OF WaN t n New Well VIReplacamenl Well E Well AaemliaYModifiralion 'Other <br /> u Mentioning Wells) #of wells I. Sal Boring(s) 4muwaxs i,Geotechnical 4muon,®� e�J2 <br />'{ n Out-OfServica Well a Oul-O(Service Well Renewal Cnus-Connectlon Repair (r� <br /> ti New Pum a Pum R lacemenl i_ Pum Repair Raise Well Casing <br /> WH Carslauc ox <br /> Drilling Method )(Mud R�oI(a y nn. r-i Auger n Cable Tool Push Point r Other <br /> A Proposed Well Depth TJ ✓ of vation 19% in diameter a Open Bapnm a Gmvel PacklGmvel Size ; in diameter p <br /> n Contlul;Wr asing In diameter I Conductor Casing�pfh it ltd) <br />'j Well Casing Diamel in ThidmessfGauge/ASTM Schad SDR t¢/7'stool )QPlaalic a stainless steel a other <br /> Groat Seal Depth 0 0 n Neat Cement(941bbagr8f0galnon d Sand Cement X10 3 sack mora gal wale, <br /> ❑Bentorme(20%sefids) D 011ier <br /> Grout PFacemmd Method KPumped rI Ree Fell a DOW n Relaidad/Accalerate,(.Me) r� <br /> PE9EeraL Installed By r Oner n Pump Contactor ❑ Other re\l`+ <br /> u Concrete Pedestal iDimensbra_WUM ft Length ftThiQ in a Chdsty Box a Smve Pipe <br /> jl <br /> PUMP KSubmersibleu Turbine a Other HP Pump set fl Blending Water Level fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <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 WITIi ALL <br /> WORKERS COMPE ATION LAWS. <br /> MINI DURA ( qp� REQUIRED FOR�� PPECu1OhS r9P�LE�ASS.E CALL 209 95 7f 97 _ <br /> Smxep � rte-rO s 1 O�GV"4 DATE (SJ s— <br /> ------------------- <br /> I 1 <br />�i <br /> i <br /> r <br /> i s AYMENT <br /> ---- --------------- <br /> ECEIVED <br />'1 <br /> 03 2014 <br /> ri - -'QuptvoONM COU <br /> •' 'N)EPARTAyTM <br /> - �� )EPARTl1EA7 <br /> Is <br /> I I k I Wit I I I I <br /> k <br /> r <br /> DEPARTMENT USE ONLY r, <br /> Data I 1 w Area DUS Cl Employee IDN l <br /> Application Accepted By rP/ ' -/r <br /> I Grout InsPecti Data El SPECIAL Well PODTIR <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth It <br /> COMMENTS 6 rr K <br /> P <br /> PE Into <br /> Received CaAmount Data Pale, Invoice# Wall too <br /> Codes Indo B Cash Remitted Service Requnet# <br />�. e�rna,+oe WB.II%IW PENxrt <br /> anwr2 <br />