Laserfiche WebLink
MOON MS:S L06 '96'ady Wli paAiaaad <br />WELLIPUMP PERMIT P,/ <br />SAN J DAOUIN COUNTY EWRONAtEUTAL HOL, TH DEPARTMENT 1858 EAST HAZELTON AVENUE -STOCK- ON CA 95205 - (2G9) 468-X2Q <br />NON-REFUNDABLE PERMIT CALL. (209) 953-7697 FOR INSPECTIONS EXPIRES i YEAR FROM DATE ISSUED <br />JOBACOFOSS 19380 E St Rt 26 Hwy o,T,,t Linden 95236 Im <br />NT 17 7 _ _ 3 n , n _ ._ > <br />Iii - i Lys- V- r_,r ��YARDELSIZE • (/ % LAND USE APPLICATIONS <br />OWNER NAMS _Robert Hampton 4 (,1+�� pHA 09-406-7786 <br />PHO <br />OWNER ADDRESS 7.615 N Alpine R 0 l(P-0&)L!2?'S CnY/STATFJZP C A 9 5 21:4,3 <br />CONTRACTOR Purviance Drillers, Inc. PHONE 209-887-3554 <br />CON17ir+CTORADDRUS P • O. Rox 64 CtTWSTATEIZIP Linden, CA 9523 <br />PHONE <br />AODREss <br />LLMMSE r cs7 _ G81 i_ M9 _ Other ,Nums R 377923 ExPIRATION DATE 7/31 /17 I <br />GEOGRAPHICAL INFORAWRON: Coordinates X Y Township _ Range Section_ <br />INTENDED USE = Domes:iaPdv2le B IrrigationJAgliaT,ural Industrial " Wafer Quahry Monilorirg .^.. So'd Sampting1charactesizatinn M <br />Pubtic Water System l <br />It di"aeii Y0m01°nEr arer ys em rte° n a maw +m �nmer <br />TYPEOFWQRK _ New � Replacement Well WeIIAherallorVModifx;alion :i Other <br />- Monitonng Well(s)_ » of wE2 is Sail Borings) A Of b dNt r Geolechnid ° dr1aA e¢ <br />- Out-OfSeroce WWI : - OukOtService Wea Ren—lal - Cross-CerinecGon Repair <br />X1 <br />New Puma - Pump Replacement L.' Pump Repair Raise Well Casing <br />c <br />�DrilUngMethod _ Mud Roiary _ Air Rotary .. Auger _ Cable Tool _ PushPcirt _ Other <br />Proposed well Depth It Excavation i, diameler <br />Open Bottom P Gravel PaddGravel Size in Qiauneterl <br />Conductor Casing in diameter I Conductor Casing Depth It <br />Well Casing Diameter_ in ThidmessJGaugelASTMSchad Steel Plastic - StainiessSteel _ Other <br />i Grout Seal D_plh tt ^ Meat Cement(9416IsaySiogalwai'er) Sand Cement 5ackmbJ7galwater <br />Sentonile(20%sorids) :Other <br />Grout PlacementMethad - Pumped 7 Free Fall -- Other =Retardant/Accelerator(name) <br />�PEDasTAL Installed By C Dmrer Pump Cenlractor _ Other <br />Concrete Pedestal :.. Dimensions: Width It Length it Thick in ,Christy Box r Stave Pipe <br />PwnP M Suhmersiblai, Turbine .: Other HP Pump Se " Standing Watertevel1_ R I <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL HE DONE IN ACCORDANCE WITH SAN <br />.IOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH TETE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WOgKERS-C-.96I_PENSATION LAWS. <br />iAINItIB24 HOOR, APVOCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 1 <br />T,TLE Corporate Secretqrpy 4-7—/- <br />°o <br />M <br />m <br />RECE vF0 <br />SPR 2,7 201? <br />H DEQCO <br />� <br />DE ARTMENT U ESI NLY <br />Application Accepted By Date Z / Area Emp;oyP-e lD� WC) <br />Grout Inspection By Date I 1tlfell Permit <br />Pump inspection By 1 Dve 0 D WAIVER Received <br />SoR 13 orfng Inspection By Date Constructed Well Depth fT <br />COMMENTS <br />4R�/12 V=•rrJ.L iPUNP P'3itG1T <br />£'d tLSU9960Z OUB Sa811uQ aoueiAind d 69: � 6 ZO 177, AON <br />