SU0004713 SSNL - Laserfiche WebLink

Home Browse Search

r r am r CONTRACTOR ADDRESS.L7 iP, CITYISTATE/ZIP SURCONTIUCTOR PHONE SVBCONTRACTORADDREM CITY/STATUZIP L.CENBe RC -$7 Cbl 0D-09 11 Other NUMBER f 3P3 E%PIRATION DATE GEOORAPKICAL INFORM TION: Cm mUnates X Y Township _ Range_ Section_ INTENDER Use matidPnvne ❑ Wigati.wAgyicultmal ❑ Indusinal ❑ Water Quality Monitoring ❑ Soil Sampling/Charectenvtion ❑Public Wafer System m v r IfeiDemuft. 0.ner ew ysnm ame Doan amew TYPE OF WORK JANe.W111 ❑ Reolm,camu t Well ❑ Well AlteratioNMedificaunn ❑ Ton HIM n n.a.. n o... ur-VI9u Y.cc wet ut1eW1-Servie Well Renewal ew Pump 0 Pump Replacement ❑ Puntp Repair ❑ C.Connection R it can WELL CONSTRUCTION Drilling Method a1g.E Rotary ❑ Air Rotary ❑ Auged Cl Cable Tool ❑ Push Point ❑ Other PraposM Well Depth ip C70 ,fl Escavatmn 12 to diameter ❑Open Bottom Ef�vel Pack/ Gravel Sim_�6_in diameter ❑CoMuctorFumg r indiameter / Conductor Cuing Depth R Well Casleg Diameter f,� in Thickmas(Gauge/ASTM Schell 7.C1;)Pj1 ❑ Swi Q11ruc Cl Suinless Steel ❑ Other Grout Sed Depth Ido R ❑Neat Cement (94/A Mrg/S-/0gal wear) ❑Sad nCement % gSACT .vm*nub; /7 gal water ❑ Bemmitte(200% solids) ❑ Manufacturer Spec% solids _% Name ❑SPecson File ❑Specs Submitted Craut Placement Method h1l.roped ❑Free Fall OOther ❑ Retardant / Accelerator (term) PEDESTAL Installed By RF6filler ❑Pump Contractor ❑Other oncmte Pedestal Dimensions: Width R length R Thick in �Chriaty Bax ❑Stove Pipe Pump ❑Turbine ❑Other HP Pump Set R Sanding Water level J6U tl WELLDESTRUCTION ❑ Open Bottom ❑ Gravel Pack ❑ Uncased ❑ Other Well Diameter _in TW I DcpthR Depth no Water fi ❑ Cuing m he perfbitce fmm _ fl m _ R Sealing Material ❑ Neat Cement (94 /A Arg 13-/0ga/ wirer) ❑ Smtd Cement nrck mix /7 gal water ❑ Bemm�ite Pell. ❑ Bentonite (20°A solids) ❑ ManuFaclURr Spec . solids _ eG Nance ❑ Specs on File ❑ Specs Submiucd Placement Method ❑ Pumped ❑ F. Fell ❑ Other ❑ Complete with Mushroom Cap R below gide ❑ Complete m Existing Surface Pad neecaaaT LaK111T asAs t nAle 1.1E lfED 1111.21 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE W WS, AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MLN71q /M 24 HOUR ADVANCE NOTIC�ISED FOR INSPECTIONS SIGNED T., �r2 DATE _ice / DEPARTMENT US L — Application Accepted By Date Arca-2— 12- Employee lDpy Grout I /a 2 ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Destmction Inspection By Dale Constrocted Well Depth ft COMMENTSP �.t40r l• iC�7 /OA �.. res__ i Lw.�_�/u a__/ art �wT PE SC Amount / ReceivM Dale Permit/ Invoicep well IDN C]oos lefo Bemillad ash B Service Rituestp JPCL / b c 2 2 :�;2CO 116 ak1 I OL EHD43-02-006 W, 3N4 neecaaaT LaK111T asAs t nAle 1.1E lfED 1111.21 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE W WS, AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MLN71q /M 24 HOUR ADVANCE NOTIC�ISED FOR INSPECTIONS SIGNED T., �r2 DATE _ice / DEPARTMENT US L — Application Accepted By Date Arca-2— 12- Employee lDpy Grout I /a 2 ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Destmction Inspection By Dale Constrocted Well Depth ft COMMENTSP �.t40r l• iC�7 /OA �.. res__ i Lw.�_�/u a__/ art �wT PE SC Amount / ReceivM Dale Permit/ Invoicep well IDN C]oos lefo Bemillad ash B Service Rituestp JPCL / b c 2 2 :�;2CO 116 ak1 I OL EHD43-02-006 W, 3N4 EHD43-02-006 W, 3N4