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6SWON 016 :01 6106 IWI J paAI ;3;� <br /> WE JPUMP PERMIT <br /> S=Jaaoum CaumwEmmcNmEn Ai-HEaL7Kt)rpA aswr I8E8 EASrHAZEL7cK Ac'atuE-StB K7w CA 95M5-(209)46&U20 <br /> _ NOWREFUNDABLE PERIMT CALL 209 953-7697 FOR INSPECTIONS EXPPXS I Y>_ARFROM DATE ISSUED � <br /> JOS ADDRESS 16975 E Front ST cmuaP Linden nden C'A 95236 a <br /> CROSS STREET Archerdale RN -/3a -¢3 Pqp GEI.s��_,�'fD LL'E ADPL1GA71OSiR <br /> OWNER NAfI a v i d PHos.�Q" -t.g-7-_ m <br /> pubox �/STQ�P Linden,Ca 6 <br /> OWN Er ADDRESS <br /> COMRACMR Purviance Drillers , Inc PlianE 209-887-3554 <br /> COirTFACTOR ADDRESS <br /> PO Box 64 C,;,,j,Tr,, Linden , CA 95236 <br /> SUOCONrtACTOR FRODIE <br /> .lvecowj AL'7URA=RESS Crry/5-mTEAP <br /> LleersE G57 a est n o t n txhel N u101� 3 7 7 9 2 3 ExPmmow DATE 7/31/19 <br /> DOMPS71C WELL SAr,Pt_J=O General MineraUCaGrorm 9acteria(4391) DflbrnmOehlOmPlnAane(4392)I Rtseilic(4393) <br /> 1'in3rDF=D USE OuTnBsticlprivale C,Irdo-atienJAgsiculWsal G Indlsltial C Wa1erO.uaTity Monilonng 0 Soil SampfingtChararieraafun <br /> G PabticYYelerSyalcn <br /> IfdilFefenl kom Qn'ne: SVtltr SysL+n Ayne Gb»txtl Xanzot Ptus+e t3imM <br /> TVPEOF WMK G Nevi Web C Replaoement Well C Well AJWWnnJAlediEca8cn E3 01her <br /> Q MDpSlcong Weu(s) ;ff-ofesells CSoleomg(s) 001tafogs G Geotechrtital =oremirgs <br /> D Out-OfServira Well r Ote-OfSen¢ee Well Renewal -:2 CassCannecU=RODair <br /> o New Pu Fum laoemenl C Pum Re ait D Raba Wall Casing <br /> WELL CONS-TRUCnOrtf <br /> DnllingMethvd O Mod RcbW C AirROtay D Auger 0 CabieTool "t PushPDiM i' Other PA <br /> Proposed Well Depth ft Ex avallan in Same ter _open Subom C Gravel PaddGravel S'ae in dunneler n�—l / <br /> D COnductor Casing in diameter I Conduchsr Cas ng Depth R /� V <br /> Well Gasing Ormeierin Tndae_WGaugeJASTMSchP� _Steel Piaslic ?Sfa6rleaSleel J 001Pr i® <br /> Groat Seal Oepih ? -3 Neat Cement(94 ib traQ-ra ga/uafe4 :Send Cement sacs m«r gat'vater �e O <br /> Q Bentonite(2U°.s scIlds) >outer a § <br /> Grout Placemant Method G Pumped D Free Fall ]Other 3 Retrtsdant1Azoleratortrrame) JOAQU ?0�9 <br /> PEnEwraL Installed By D DAIISr 7 Pamp COnRadar D other T,RONMF pUNTy <br /> C!Concrete Pedestal COlmenstO=Midth ft Lw g tlThick in 1 Ch6M Bax ,Stave Ptpe <br /> Pump i Sutmers�le0 Turbine 7 Otheft r HP Fsmrp Sel Standing Water Lesrel n H 0' p JR M NT <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THS APPUCATION AWD HAT THE WORK WILL EM OWE IN ACCORMNCE WITH SAN <br /> .10AQUIN COUNTY ORDINANCES,STATE LAWS, AND RUI.Es AND REGULATIONS I ALSO C J;EnF-Y THAT OaY REQUIRED LICENSE 15 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT t ANI 103 COMPLIANCE WITH ALL <br /> WO PENSATION <br /> flflllUl M 24 F CE NOTICE REQUIRED FOR IMSPECTIOMS-PLEASE CALL(20�]9z69 <br /> 5>c �Orporate Secretarzy,E 1 11 <br /> o,'"y :. ,' <br /> I II jr I I I I <br /> ! f I I ! I I II I ' I I 1 <br /> 7-1 F1 <br /> I I I I III <br /> II Il I II <br /> Lj <br /> L Lig <br /> I j l I <br /> i <br /> i <br /> NT Il///��,,,S`E//'ONLY <br /> Applit.didn Aaapled ByAk==� <br /> a�-7 Z 1.1.� 1- i I!>n <br /> GroutInspectionBy 11 �1 PECWLW211P2>fitit <br /> Pump Inspe bon By RAQA N (,.doQEG V�Dace Z-1 � WArvm Received <br /> Sod Boring ImpBP Date Consirucled Well Depth fl <br /> COMMENTS <br /> PE Sc Received the cldG Amount Permit! trtvo;� Well 109 <br /> rlOdes_ ._Info.. _......Remitted Dam_ .. Service.Reauest� .- -— --• <br /> I <br /> I <br /> i <br /> I i <br /> EFD--3,-'- WInG 72-3E <br /> Z-d Dul SlalluQ aOuelAlnd 09b:OL 6l �8 U8 <br />