Laserfiche WebLink
WELL 1 PUMP PERMIT <br /> SAN JOAQoN COUN'fv ENV1RONMENTALHLALTN DEA ENT 3PI E WEREu A VE 3�"FL-SI UCICI'UN CA 15302-I1VY1-I66-14111 <br /> NOR'-REPUNDABLEPERMIT CALL 209 953-7f)97 FOR INSPECTIONS EXPIRES I ,,'EAR PROM DATE ISSUED <br /> 71 <br /> Jon ADDRESS _ CITYfZ.II I 3[�� _ O <br /> CRWSSTRF..E APIN C PARCEI.S1zE LANK 115F,ArP cATSON l{ <br /> O.VN,ERNAa1L <br /> OWNKR ADDRESS C1'EVISIATUZ-G l7+.Jr ] <br /> CCONTRACrOH ✓" /•✓C- '/ /l: / /�'��PIION�F?r / / / <br /> Ct)NrsucrOR ADORES. ..1..� •_��`'�. { - CITVISTATF1Lri�f'-'�`-�"'^ <br /> SVDCON nA TOR FIIONY <br /> SVRCONTR URARDRMSN C1J.5CT�/nT£/'J,IP <br /> LICENSE -$l ❑C-GI ❑D-09 ❑6lher' NUMBER V! EIIPIRA'I'1ON 11h'lE 0 <br /> C.EOGRAPRR:ALINFORMAT11I Coordinate, X Y_ Township__ R9ng4 Scctiun_ <br /> IN'IY.NPF.D U5E U DomestidPrivale ❑leigatienlAgrieultural P lodnau)al U Water Quality Menitcl Ing ❑Suil SamplingrCharaelerisation <br /> Public War di ltr Syst2_ a _ <br /> ublie rent from OO L-" v vsle • V °'e i � <br /> TYPE OF WORK ❑New Wdi ❑Replacement Wcll LI We11 Allemlion/hladiLcalion ❑Olher _ a <br /> qaf wills ❑Sail Horin xornwinee p(.culu:llnical nofho.i�ys <br /> ❑Moniumng Wdl(s) E(s) $ <br /> ❑Oub06Service Wrl1 ❑Out-Of-Service well Rencwal U Cirem-ComR iml Repair 'D <br /> U New Pum -❑Pum Replacement ❑Pum Rc ai, <br /> y <br /> WELL coNsrRPc 1oN rn✓r <br /> Drilling Method Ips led Sultry 0 Air R[a <br /> ary LI Auger ❑Cahlu Tnnl 11 Push Pain[ L Other <br /> Proposed Well Depth C�- Q�n E.—Iion_,-1, L in diamcmr ❑Open Hotswn timvel Pnckl(lnrvd Sir ilr diameter <br /> ❑Conductor ng indiarrretcr 1 Condu,I?yCesing Ucput Ir <br /> Well Casing Diameter kVI. Thickne-s GaugdASTM Schad,_ Steel 9 fl„sGc ❑Sta[oless Stccl Ll Oiler <br /> Seal Depth n'-—H ❑Ned Cement(94 th Arg/S-1Rgul waiter) fl"fvSand Cemenl 1 G..� vack rnir 17 gal water - <br /> -❑Rcmonile{2P°/.solids) ❑Manu!'acturcr Spx%solids__% Name ❑Speus nn F'de ❑Shes Suhrnined (� <br /> OI»ut Plsunaens Mrtlood Pumped ❑Free Fall ❑Other U Revii-Ont 1 Acceluratoo <br /> PEDESTAL Installed By 13 Driller U Pump Conlractor ❑ Other <br /> ❑Concrete Pedestal Dimensions:Width tl Length RThick in ❑Christy Hua ❑Stove Pip, <br /> POMP USubilmlible ❑Turbine UOther HP—_PumP Set It Standing Water Level (t <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE.IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND RE(.IILAT1ON5. 1 ALSO CERTIFY THAT MV RF,Q111RED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS S'TAIE LICENSE BOARD AND THAT I AM IN COMPLIANCE-WITH ALL <br /> WORKERS COMPENSATION LAWS <br /> MINI 1)M 24 ROUR ADVANCE NOTICE 11 UIRED FOR INSPECTIONS <br /> Till-F. DAIr <br /> I <br /> - I I <br /> N rs <br /> NT <br /> H.',tLF AH <br /> E�PpA�R T M E N T U S E ONLY <br /> NLY - <br /> Appli-Ii et A—IeW IS - �irf'k" L' 4'v+l Dalc p !.�{/f0 Aruz__ lirnpioYu�IIIn <br /> Iimm Inspec[ien By Date �— ❑ SPECIAL Well Permit - <br /> Pmnp In,p'liar By Dmc 0 WAIVER Received <br /> Cnnstrucled Well Depth It <br /> COMMCNIS — <br /> PE SC Received Checklr+ Amonnt Dale Permit! lnvaiceN Wen IDN <br /> Codes Info E ash K—— Service Re ucsto <br /> t g If , <br />