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S61O'ON WdSO:ti 9 l 0 Z W'�)O omit p;AI;); <br />WELUPUMP PERMIT f <br />SAN JOAD:IIN COUNTY EWRONMeNTAL HEALTH DEPARWENT t 868 EAST HAWLTON AvMue - STocwroN CA 9520S - 12119),162-3420 <br />VOW -REFUNDABLE PERIiliT CALL (209) 953-7697 FOR INSPEC'nONS EXPIRES 1 YEAR FROM DATE ISSUE=D <br />JOBADDRESS A0389 E Walnut Rd anyrJP Linden CA 95235 <br />CROSSSTREET Fine R D �? 7 APN xt-' Q ,tivpppCELStZF�Lt, UsEAPPUCAnCM9 <br />G' <br />OWNER NAS Julie V R. E l l r S Clary PHONE 16 <br />orajER ADDRE,, 1405 36th Street Cr1Y1STA7EhJP Sacramento CA 9581, <br />CONTRACTOR Purviance. Drillers, Inc. PRo»E 209-887-3554 <br />CONTRAC= ADDRESS P. Os Sox 64 _ CMJSTAIFJZP Linden, CA 9523 <br />ADDRESS <br />'r L : <br />PND?lE <br />CTTYlS'rATFIZJP <br />377923 t] PIRASI9V DATE 7 13 1 / 17 <br />GEOGRAPHICALINFT]R.MATt0N: Coordinates X Y Township _ _ Ranne SectiDn <br />INTENDED USE :J Ocrneslic Pdvale ! Iniga ionlAgncullural I. Industrial :- Water QualityMonitoring i Soil SamplingfCTararlerizadon <br />l <br />Public lvarerSystem <br />IrdtT°r¢m ham Owner_ er Kem me naa°rtra or re. r <br />TYPE UFYYCRR _ N --W W21I _ Replacement V ell _; Well AlterationlModifiratien _ Other <br />VOTROFing Well(s) mol watts :: Soil Boring(s) ac1bo .W r Geolechnical <br />-- Out-OfServlce Well OubOFServic VVV? Rene.ral _ Cross-ConnecUDn Repair <br />NeyrPUmo ftPurno Reolacemmt G PUmo Renair -Raise won r..e­ <br />Cnlling McLtiod Mud P.otary Air Rotary -Auger _ Cable Tool : Push Point _: Other <br />Proposed Well Depth ft Excavation is diameter Open Bollom C Gravel Pac)dGrdvel Sae in diameter <br />_ CondurAorCas6-Ig indizmeter I Conductor Casing Depth II <br />Well Casing Oiamder_ in TJhicknessJGauq0ASTMSche6. ^_ Sleet -:I Plastic - Stainless Steel 011ie <br />Grout Seal Depth 8 _ Neat Cement (941bbagr540garwafer) Sand Cement saumixlJgal water <br />Bentorle (20 o solids) •- Other <br />Grout Placement Mettrod = Pumped ;. Free Fall Other Retardant I A=Neraldr (name) <br />IP EDESTAI_ installed By = DNler ; Pump Contractor - Other <br />Can creto Pedestal LDimensiorTs:Wdth It Length ft Thick in Christy BOc U Stove Pipe <br />Pot.!P V SUbmerslbleL: Turbine .: Olher HP P <br />ump Set ft Slanting Water Level /57 R <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 ACnVE WITH 'raE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I Aid IN COMPLIANCE WITH ALL <br />MIN1M24 U A$1/ANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 <br />SIGHED �� TT E Corporate Secretgc; r,y lo-i(9to-i(9 <br />Pt <br />RTMENT USE NLY <br />Apffcation Amepted J Date ro t 6 <br />Grout Inspection By Date <br />Pump Inspection BY f VV Date <br />Soil Bor(rg Inspection By Dale <br />COMMENTS <br />Info � h Ramified Oate <br />� 0�.37�iJ 10, i10-zH-I�; <br />r`HDayas <br />1/r M7 <br />L 6'd �L98L8860Z <br />to <br />0 <br />d <br />m <br />ie <br />�Elvro <br />r 2,32016 ,32016 <br />HF,gLTH <br />ArcaEmployee II���Oa C c.0 <br />3 PECIAL Well Permit Z W t= <br />(V <br />7 WAIVER Received CW <br />%.. -,- <br />,t4 <br />Constructed Well Depth ri C W Cq <br />�t WWM <br />Invntrn+l' Enron rrL Lin O <br />? Request Y. <br />76 742 <br />.M <br />VJEU mU?.V PERMS <br />I - <br />z <br />0ZCr <br />zWa <br />=0U. <br />�. <br />a�= <br />�Z~ <br />ZUJ4 <br />QW <br />Ln x <br />OUB Sa811iJ4 aOueiA)nd dt7�: � 6 ZO OZ Ae" <br />