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WELL/PU7MP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTALHBALTH DIMION <br /> 304 E WEBER AVE-THIRD PIMR STOCKTON CA 95202 (209)468.3420 <br /> NON ABLEJJPERMIT EXPIRES 1 R FROM DATE ISSUED <br /> JOBADDRESS��_yf,0t S. �a(Q ': <br /> AI'N a 7q,62 'L <br /> CLTYlLIP CELOWNER NAME DRESS 5!•. <br /> Cm21P PHO <br /> CONTRACTOR ✓ W 'bielLLI-JS DRESS P o 0 <br /> a 57 <br /> CIIY¢IP�tO- 1/7S r'/�' 9�✓.�7/.-_PFTONL; ^l/ 7 7 7 4/O-o <br /> G57I.ICENSBA�24>�/ DATT3__ <br /> GEOGRAPHICAL INFORMATION- COORDINATES X_ y_TOWNS pAejG E_SECTION <br /> - TYPE OF WELL: O NEW WELL 13 REPLACEMENT WELL Sgt y y� S <br /> MONITORING WBl1.N�_�I]O� <br /> INSTALLATION: O WELL SYSTEM REPAIR 13 CROSS-CONNELT REPAIR O VAPOR EXTRACTION WELL N <br /> TYPE OF PUMP: 0 NEW O REPAIR H.P. DEPTH PUMP SET SFT. FIRST WATER I$VEL <br /> O OUT-0P-SERV{CE WELL O GEOTECHNICALA 17 SOI.BORING O DESTRUCTION: <br /> E=D USE •TYPE OF WR1a. CONSTRUCTIONS <br /> I O INDUSTRIAL O OPEN BOTTOM WBLLEXCAVATTON DIA_ S 1 CONDUCTOR CASINO DIA_A[& <br /> E Q DOMESTIC PRIVATE L3 0A <br /> PACKlSIZB E•G O WELL,GSING WELL CASINO DII�a � <br /> OPUBL.ICJMUNICIPAL 13 DRIVEN GROUTSEALDEPrH SPECIPIGTION <br /> IRRIGATION/AG OTHER GROUT BRAND NAMEh <br /> "ON11OR1N0 GROUT SEAL PUMPED: OYES ONO <br /> 13 CHRTSTY BOX IKSTOVEnPI�M CONCRETE PEDESTAL B DRBI.ER: 11 yE4 O NO <br /> APPROXIMATE WELL DEPTH gj _ aV*#Uzb" <br /> PROPOSED CONS'IRUCTTONlDRI,L,INGMETHOLJ: MUD ROTARY_AIR ROTARY,_AUGER CABLE OTHER d <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUI14 COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS.I ALSO CERTIFY THAI'MY C•C LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> MINIMU OUR ADVANCE NOTiICE REQUIRED FOR INSPECTIONS <br /> r` <br /> j SIGNEDSCS " 6444112-5' A <br /> "a WAIM MAN of 0D mym T <br /> t <br /> 709-0]0-4 <br /> 33 34 <br /> VER LINE <br /> .2m-aa-s 4 3 <br /> 209•-170-2 <br /> OA y� <br /> BJn 209-040-9 L91L OF <br /> 'Q7, OII IID. 709-160-09 RF <br /> l +�n <br /> 209-160-1 209-160-2 _�. <br /> 209-310-9 •-�.I_ <br /> DF SANJO 1x tnlE <br /> eEnlellr tm.\ <br /> m-iw-a <br /> 709-190- <br /> � <br /> �D USE ONLY <br /> f pp Aceapted By <br /> Application A ® �D <br /> IPmN <br /> Grout I9apeetlon By '� panedy to 1`5'oJ <br /> bestnutian Ins <br /> rr <br /> COMMENTS. I- <br /> •^- sflT L.a*T?*&.) <br /> PE Sr AMOUNT CHECKN/ RECENBp DATE PERM JORVICEREQUEST# INVOICE N <br /> CODES INTO REMITTED CASH BY WE[L 1DN <br /> S S� 3 ca q b - Sz <br />