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0816 'ON Wd80 :8 C10Z '86 '3ny awil paAiaaad <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONNFJJTAL HEALTH DEPART11"T 1868 EAST HAMILTON AVENUE-STOCKTON CA 962DS-(289)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED r <br /> Joe AODREss 5229 St R r 26 43z (CA-26) CITYILP j s <br /> CROSS STREET Cardinal APN10104005 <br /> PARCELSI LAND USEAPPLIGATION# iA <br /> owNER HANE Joe Gotelli & Sons P1110NEZ09-931-4392 is <br /> OWNERADDBeSS 9189 N Ashley L n1 A o yqk- tTr15TATso S t o c k t o n CA 95212 <br /> CONTRACTOR Purviance Drillers , Inc _ PI,o„209-887-3554 <br /> coNTRAcTOR ADDRESS P .0 ,Bog 64 pn./gTq Ip Linden, CA 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATE01P <br /> LICENSE /L C-57 ;.i C-61 11 D-09 U Other NUMBER 3 7 7 9 2 3 ExPIRATION DATE 7/_7 T 7 <br /> GBOGRAPIrlICAL INPomax a7r. Coordinates X Y Towrlship_ Range Section_ <br /> INTENOED USE .DomestclPrivate /irrigation/Agricultural rl Industrial .J Water Ouality Monitoring -_Soil SampringlCharactefteliion <br /> Public Water System <br /> it allerem ham Owner. W-MOYSYSIeMNaMO uon= ame orow-rquffVer <br /> TYPE CF WORK J New Well _ Replacement Well J Well AllerationWodification _Other <br /> Monitoring VVell(s) g of wels fl Sol 8oring(s) r or borings Geotechnical 11101 ob1i.q. <br /> r;Out-Of-Serviceell fT OId-Of Service Well Renewal I"Cress-Connection Repair <br /> !^:Naw Pum Pum Re lacement u Pum Repair I.. Raise Well Cas%n <br /> WELL CONSTRUCTION <br /> Drilling Method u Mud Rotary ! Air Rotary -:Auger Cable Tool !Push Point Ll Other <br /> Proposed Wag Depth R Excavation in diameter L'Open Bottom O Gravel Pack/Gravel Size in diameter <br /> J Conductor Casing in diameter / Conductor Casing Depth it <br /> Well Casing Diameter_in ThicknesslGaugeIASTMSchad I';Steel p Plastic _Stainless Steel C Other <br /> Grout Seal Depth a u Neat Cement(94/bbag15.10gat warei) J Sand Cement sack ff*f7 gal water <br /> %.BeMonile(20%solids) f?Other <br /> .G7out Placement Method Pumped ❑Free Fal =Other G Retardant I Accelerator(name) <br /> 'PEDESTAL Installed By ii DRger a Ptanp Contractor V Other <br /> t Concrete Pedestal_Dimensions:Width N Length ft Thick in :1 Christy Box a Stove Pipe <br /> ,P SuhmersibletI Turbine +J Other HP Pump Set fl Staring Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCA71ON AND THAT THE WORK WILL 43E 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 CALFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WDRK OMPENSATION L� <br /> NEIN UM 24 D NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL{209)953-7697 <br /> S.- TrTLECorp Secretary DATE8/28/17 <br /> 1A t <br /> M T <br /> N �oVN <br /> 61Z co ED <br /> `� UJ �- 8 <br /> Z � I l 2011 <br /> 0w Ut V C <br /> > ° OUNTy <br /> �A ENT <br /> P <br /> Lu 1 RTMENT <br /> ill IHI <br /> P RTMENT U NLY ��rf� <br /> Application Accepted By Date`� Areae Employes IDNCS�V D <br /> Grout Inspection By t��I _� Date ❑ SPECIAL Well Permit <br /> Pump Inspection By FC��C�JU m Yt'\I.YMv Date �q Q 0 WAIVER RecelVed <br /> Sol Boring Inspection By i prate Constructed Welt Depth N <br /> COMMENTS C-U Q <br /> C60 ctcc f 1-1 <br /> PE SC Received CltectdN Amount Dat PerTrdV ITlvoiceil well IDN <br /> Codes Info B Cash Remitted i e uest# <br /> .01 2� . <br /> Diu 3 i . <br /> RID 63-ae WELL IPUVP PERMT <br /> 4,3(02 <br /> £'d VL5£L9960Z out sjeiiij4 eoueinand dt0'1£0 L L 8Z Bny <br />