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WELL/PUMP PERMIT ���� � <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL;HEALTH DEPARTMENT 304 E WEBER AVE 3"FL-STOCKTO JI620 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> I rn <br /> JOBADDRFss 28501 N. Mackville Road , crrv/zIP o <br /> CROS$STREET Liberty Rd. APN DD9'�-I20-O!/ PARCELSIZE,3fr7"-!LAND USEAPPLICATION# <br /> OWNER NAME Nestor Enterprises PHONE <br /> t <br /> OWNER ADDRESS 13852 e. Peltier Rd. CITY/STATEIZIP Ca Acampo, CA 95220 <br /> CONTRACTOR Purviance Billers, Inc. PHONE 209-887-3554 <br /> CONTRACTOR ADDRESS P. O. Box 64 CITY/STATE/Z1P Linden, Ca 95236 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRPSS CITYISTATE/ZIP <br /> l <br /> LICENSE M C-57 ❑C-61 ❑D-09 ❑Other NUMBER 377923 EXPIRATION DATE 7/31 /67 <br /> i GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ❑Domestic/Private 10 Irrigation/Agricultural ❑Industrial ❑Water Quality Monitoring ❑Soil Sampling/Chancterization <br /> ❑Public Water System <br /> if different from Owner: Water ynem amWtset ame ar a umber <br /> TYPE OF WORK W New Well ❑Replacement Well O Well Alteration/Modification ❑Other <br /> a orbori.P C3 Geotechnical a of borings <br /> ❑Monitoring Wells) #of wells ❑Soil Borings) <br /> ❑Out-Of--Service Well ❑Out-Of--Service Well Renewal ❑Cross-Connection Repair <br /> ❑New Pump ❑Pump Replacement ❑Pump Repair <br /> WELL CONSTRUCTION -1 <br /> DrI1Hog Method §1 Mud Rotary ❑Air Rotary ❑Auger ❑Cable Tool ❑Push Point ❑Other C/) <br /> Proposed Well Depth 6 0 0 ft Excavation 22 in diameter QCOpen Bottom ❑Gravel Pack/Gravel Size in diameter O <br /> ❑Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 16 in Thickness/Gauge/ASTM Sched -?.So _ IXSteel ❑Plastic ❑Stainless Steel ❑Other <br /> Grout Seal Depth 3 6 0 R ❑Neat Cement(94 lb bag/3-l0 gal water) aSand Cement 10.5 sack miT/7 gal water <br /> ❑Bentonite(201/6 solids) ❑Manufacturer Spec%solids % Name ❑Spas on File ❑Specs Submitted <br /> _Grout Placement Method 0 Pumped ❑Free Fall ❑Other ❑Retardant/Accelerator(name) <br /> 1 PEDESTAL Installed By ❑Driller ❑Pump Contractor ❑ Other d <br /> I ❑Concrete Pedestal Dimensions:Width R Length ft Thick in ❑Christy Bos ❑Stove Pipe <br /> 1 PUMP _ O Submersible N Turbine ❑Other HP Pump Set ft Standing Water Leve] It �a <br /> III I 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 REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> `ft CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> { WORKERS COMPENSATION LAWS 1 <br /> I ^�INIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> ( SIGNED <br /> Qt��l �e!e%s�-r 'e TrrLE Corporate Secretary DATE 11/1 /05 <br /> L 1 <br /> ILI <br /> i 1 <br /> l <br /> a . L <br /> 1 <br /> I La <br /> �I <br /> C <br /> J <br /> "-DEPARTMENT USE ONLY <br /> Application Accepted B /U!/��J. Dam !f A. <br /> Grout Insp n By Date <br /> �t�� / <br /> Pump In ' <br /> Date r��/c :r•:dl'Y/�a.J7 / <br /> Constructed Well Depth <br /> COMMENTS O[-d L.or o f--4*-c-0 4-6 <br /> PE Sc Received Chaldl/ Amount Date PermlU Invoice# Well 1D# <br /> Codes Into B Remitted - Service Request# <br /> 1- <br /> (F3.61, '20 <br /> to 4-0 os o fro•L>,D <br /> 1. <br />