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1049 <br /> WELLIPUMP PERM1 <br /> Smi Joaouirt COuwy Euvr^.o:rar-uTAL HEALTH DEPT I3GU East li zelton Avenue-STOCHTOu CA 95205-6232-(20914GS-342C <br /> NON-REFUNDABLE-PERMIT CALL(204)95.?.-7691 r . EXPIRES 'I YEAR FROM DATE ISSUED <br /> - _ <br /> Jos ADDr._tz 30261 S Airport Way CrrYPLtP Manteca 95337 <br /> D <br /> CP,O :s T RrET Kasson APN 241-37-007 PARCEL.SIZE 12.55 Lxio USE APPIJGAT1os- a <br /> m <br /> v <br /> OW;;E:�NA%,c Manteca Sportsman Club _ PHONE(209)-204-2510 <br /> O:vv_;:aDDar_a SAME CIIY/STAT&?J1, <br /> Covzr,,CTON vel to ViIinp I ii(-_ PHONE {11)9)466-9625 <br /> JCONTRAC7o:i ADORE" 646 S. California St Cnr/STArE/Ztr Stockton, CA 95203 <br /> ISUUCONTUACTDIt .—.--- -- PHONE <br /> I S000ONTRACTOR ADOR=—�- Cn YISTATLMW <br /> LICENSE <br /> C-s7 >RG-i51 0-09OL'ter NutuaErt 1 0 5 5 43 4 ExinRAnou DATE_ 07/31/2021 <br /> L--- C----- -- -- <br /> GEoGRAPHtc aL IraroRuAmon: Coordinates X Y Township Range Section - <br /> INTFNOLD IIsi-, x C;r;,esuciP;v;ata lsi9a11oNAgneL.tural Indus:rial "'alar Duality Mont:or'lig ; Soil Sampling/CLaraclerizot:0,i -- <br /> PUNIC!'.'alf r$yuan <br /> tYPr OF YJGt.: \c17 l7c'J Mer-.jon1&1odi.ic ij:;n Dthcr _ � <br /> i.lunitonn+:l�/at!(si c.`.: ii; Sc,lEoc:ngts) "`''- Gsolactimcal_ �P <br /> Gut-Ct-Sen+ic•.? Cu:-OI-SePn:.a ME RenL riat Crca-Connecter.^Repair c p CV <br /> yL•::Pc_m_, - ?u no Rcaiacernent_ x Puno Rvaair_ — R,u_sa:Yulf Car,= �D <br /> WfLL CON`;'-RLCTtM Drilling i4etilod i.:.i;:..c ar; r .a'. ry Auger Cawe Tool . Pu:11 P434,11, Ct'er OCTG• � 20?O <br /> i'ropo.cd Wet! Dei1U1 t: Excavatiar, in diameter ONn Bcttcm Gran Pack'Gravel Sizc4JQ�(r7�j t. <br /> 1 9 Ccnd xtar Ca:aru, u:is r;u:Iur t Ccrulactor Castng Dvpih t �TN�EACC77�VVTjj//����COU/ TY <br /> Nell Casin Di;nra.:•_ in Tt,ic ness,'Cauge/ASTIri Sehed steel Plastic Starless Stuel Oawr TMFNT <br /> Grout Sual Depth ;t Neat Cement(94 lb bag%3-IUgal 1Yattrr) Sand Cunient sack neiu7!Id%vJtU <br /> 13untautc Other <br /> Grout Placement Method Pu:_K.ud Fruu Fal! r Otter — Rl tariLtnt 1 Acce IL r.11tir(nam.) <br /> PeDrsrAi-- Installed By Orii6r Pump Contractor Mot <br /> Concrete Pedestal Dimers;ions::Lith It Thick _to Christy Box . Stove Pipe <br /> PUMP xSubmcrs:&& lail;lau Other HP 80 <br /> _ _ — Pany1 Sui_ __ ;t Stand,nr 1Matcr Lc:a i 20 It <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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I A 1 IN COMPLIANCE WITH ALL <br /> WORKERS CONIWNSADON LAWS. <br /> 24 HOUR ADVANOE NOTICE REQUIRED FOR INSPECTIONS <br /> StGNLO IITI.L CEO 1D/01l2020 <br /> DATE <br /> r <br /> -._ <br /> J /DEPARTME= NT)) USI ONLY 'fir <br /> :.p;�GcJL.x A:cCpt—!.-y jrf /'l/ F � �+r HE <br /> Grout <br /> Cmployev to:. <br /> Grout Ir.c;pect,on iiy D .rJPECIgL Well PePRlit <br /> Pump Instlle tion 3Y -- <br /> Z l�:i:t: �l � ! 1 /2oZ0 WAIVER Received <br /> S:i!9ontxl Inspection By Constructed Well Depth fl <br /> CONIMEYT'- — — <br /> PE SC Received I C:1eck::: Ainount - ---- Permil/ I - — <br /> Codes Into _ByRemitted Dale Invoice# Wall log <br /> I Service Request Sl I I <br /> X77 ------ <br />