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1 <br /> 89WIN WdD:2 9106 'll 'qad awil paAI ;3;� <br /> WELL/PUMP PERMIT <br /> SMI JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZEL roN AVENUE•STOCKTON CA 95205-(2109)6633420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> LA <br /> Joe Amuss 4806 E Mariposa cITympStockton CA 95215 D <br /> C.=STREET C a r p e n t e r ED APN l 7C PO IC) PARCELskzE 1' _LArlDuae APPL1CAnON# <br /> OWNERNAME Lv�;.;, 7k�n���i� �:,lh�� PHatE209-406-1731 <br /> O"rRADLREW 4806 E Mariposa RD cmrsTAwrzPStockton CA 95215 <br /> CorrrnACTOR Purviance nrillers, Inc. PHavE 209-867-3554 <br /> CONTRACTOR r40DRESS P. 0. RO X 64 CrTYISTATFMP Linden, CA 9523 <br /> SUBCONTRACTOR PHONE <br /> SUaCONTRACTaI AODREss _ CIT)STATEMP <br /> LICENSE a r—r a C-B1 a D-w a other NUMBER 377923 E...-ION DATE 7/31 /17 <br /> GEOGRAPHICAL INFOFdAATON: Coordinates X Y Township_ Range Section_ <br /> 'INTENDED UsE i►DomestldPrivate C Irngatian/Agricultural tl Industrial -I Water QualitytAorAarEng ❑Sod SamplinglCharacterization <br /> L.1 Public Water System <br /> eGR�rerd hom Orrllaf. er em an —or ne um <br /> TYPE OF W ORK U New Well _Replacement Well u Well AlterationNodigwGon LI Other <br /> C Monil&ng Well(s) if of wells ^ Soil Bonng(S) pa tnrin4s ,- Geotechnical aufennnas <br /> t I Out-OLService Well n Out-OlService Well Renewal n Cross-Connection Repair <br /> C New Pump IN Ptnp Re lacernenl 2 Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method u Mud Rotary :-Air Rotary u Auger a Cable Toot j Push Point L Olher <br /> Proposed Well Depth ft Excavation In diameter D Open Bottom U Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter I Conductor Casing Depth it <br /> Well Casing Diameter_in Thidmess/Gauge(ASTNI Sched G Steel ❑Plastic C Stainless Steel ❑Other <br /> Grout Seal Dept n D Neal Cement(94 Ib bag(SlO gal water) t:l Sand Cement sack rnrbr(7 gal water <br /> n Bentonite(20%sdids) i I Other <br /> Grout Placement Method C Pumped aFree Fall COther C Retardant I Accelerator(name) <br /> PEDESTAL Installed By 17 Driller C Pump Contractor = Other <br /> I_I Concrete Pedestal L Dimensions:Width ft Length ft Thick in Christy BOK j StDVe Pied <br /> PUMP •Submersiblau Turbine I I Other HP Pump Sel 2_0ft Standing Water Lew[ f ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILLBE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IIS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPtJANCE WITH ALL <br /> WORK COMPENSATIO <br /> MINI M 2 U AD ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIONE Trn.E Corporate Secreta,;�W o;?//-/(o <br /> REG <br /> FE <br /> I <br /> p <br /> ENVII RN' i ,QFcF F'VT <br /> O <br /> nx <br /> DEPARTMENT U"E NLY <br /> — I—�—CI— --� lJi4s I I V <br /> Application Accepted B Dale Area l ERipICye9 I Oft <br /> Grout Inspection By Date D SPECIAL Well Permit <br /> Pump Inspection By Dale D WAIVER Received <br /> Soil Boring inspection By Date Constructed Well Depth tl <br /> COMMENTS Nr'% moi" Z�W -- <br /> PE SC Received II Check/# Amount Date Permit Invoice# Well ID# <br /> Codes Info 1 Cash Remitted .. Service Request# <br /> 512 00143. <br /> I <br /> I � <br /> Ar"12 IYEiL fPU�P:JtMfr <br /> Z-d 1399:t,0 60 L l deS <br />