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o A aAia�a <br /> � N wd6Z � < < c�oz Nz � w awi 1 P <br /> WELLIPUMP PERMIT <br /> SAN JOAOuW COUNTv ENVIRONMENTAL HEALTH DEPARTMEMT 1668 EAST HAZELTON AVENUE-STOCicTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 9 YEAR FROM DATE ISSUED <br /> 16672 <br /> 6672 E S t Rt 4 Hwy <br /> 6 Stockton, C k 9521 <br /> JoeAooxFss <br /> CROSS STREET io11enbeck APN18315003 LN 0APPLCAnON <br /> OWNSRNME Celli Brothers LLC -r� 9-993 r <br /> m <br /> 1. „ <br /> ONE <br /> o>,wnAODREss6161 .Cherokee Rdf.(RD �(,(A-t.�lf/�l ISTATEMP btockton , CP. 952 F2 <br /> CONTRACTOR Purviance Drillers, Inc. C`kA\\ L6 7 PHONE 2n9-887-3554 <br /> •CoNTRAc:TCn ACDRSS P. 0. B o x 64 CITYISTAT&ZIP T-ti nd e n, CA 9 5 2 3 <br /> SUBCONTRACTOR PHONE <br /> SUBWNTRACTOR ADDRESS Cr YISTATEI&P <br /> fLIGELSe 6XG-57 _C-51 1;D-09 Other N6MaER 3 7 7 9 2 3 EXPIAAnON DATE 7/31 /17 <br /> GEOGRAPHICAL INFORuA-noN: Coordinates X Y Township_ Range Section_ <br /> WEENDEC USE DOmesti.UPrivate TC InigaGon/Agricultural C Indusldal _ 'Neter Quality Moniloring r.Soil SamplinglCharaclerizaTon <br /> Public lNatar System <br /> Ifdltfixeal irme owner; r ys em rn: or ne �moer <br /> TnEOPWORK _Newt'Vell _Replacemenl Well :..Well AlteralionlMaMiialian Other <br /> -Monitoring Wei(s) ''.of Walls 1,Sall Boong(S) a d barings Geotechnical Tortonngs <br /> Ou(-Of-Service Well 7 Out-Df-Service Well Renewal !7 Cress-COnnection Repair <br /> Now Pump X Pum Re lacoment :_Pu Repair Raise We¢Casio <br /> WELL CONBTRUCTIOU <br /> Drilling Method �Mud Rotary _Air Rorary ..Auger -Cable Tool _Push Point _ Olher <br /> Proposed WeII Depth R Excavation in diameter _Open Bottom =Gravel PacPJGravel Size In dimne:erl <br /> _ConductorCasmg In diameter f Conductcr Casing Depth fl i <br /> Well Casing Diameter in Thicloless'GaugeIASTM Sched Steel �Plastic :Stainless Steel n Other <br /> 1 GroorSea) Depth R Neal Cement(94Rr6agS-fOgalwater) L;Sand Cement sackniKffgal rrler <br /> -Senlonlle(2056 solids) Other <br /> GrautPlacementMethod Pumped •Free Fal -01her ReWdant+Accelerator(narre-_) <br /> I PEDESTAL installed By =Del'ger Pump Conliactor Other <br /> I_ '_Concrete Pedestal Dimensions:Width R Length R Thlch in ..Christy Boz J Stove Pipz <br /> PUMP ..:Submersible Pr Tutlrine ::OIheTHP IOO Pump se fi Standing Wafer Level 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. I ALSO CERTIFY THAT MY REQUIRED,LICENSE iS <br /> CURRENT AND ACTIVE VYITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WYM ALL <br /> WO COI47PENSA�A . <br /> Mf UI!7NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209) 7 <br /> SIGN T:1, Corporate Secrete M/ 17 7 <br /> ' II I T- <br /> L <br /> I I <br /> I I I i I I <br /> I I I I <br /> I o i <br /> 1 I ! f M <br /> I — l <br /> M; M <br /> I ! i m l � � <br /> o <br /> M <br /> z <br /> it <br /> otill 44-11 <br /> e <br /> I I In= <br /> REGI <br /> 1-7, I <br /> EP RTMENT USE ONLY <br /> SAN��yIRpD�PARE <br /> N�ySH AWicalionAccepted By Dale Area Emproyee IDT' <br /> Grout Inspection 3y_ rr'' t, Date :1 SPECIAL Welt Permit <br /> Pump lnspeaunBy G � bit o Da:e D WAIVER Received <br /> Scrl Boring Inspection By Dale Constructed Welf Depth fl <br /> COMMEINTS <br /> PE SC Received Check"./ Amount Oate Pennitl tnvoice>r Wel31Dg <br /> Cotler Info 8 h Remitted <br /> i� a 0��7�jI NON 329 <br /> E•d tL90L8860Z oul saelllaa eouelnand d I,Z:90 ZO 0£AON <br /> 71 <br />