Laserfiche WebLink
' WELL/PUMP PERMIT <br /> -.*AN JOAW;N OX''N1'v E3WY1RnNM1'NTA1.'Ir.ALTH btlARTMENT 304 E WEBER AVE 3'"FL-STOCKTON CA 95202-{209]46'8.;4Z0 <br /> NON-REFUNDABLE PERMIT CAL 1209)953-7697 FOR 1NSPE IONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jus ADDRESS <br /> CROSS STREET W C L///7 •pN _ -y')k —P�CELSLLE�!!LA UWAPp CA?IONtf <br /> Ovvqt Licetl <br /> NER�IAMF. li -TT`— <br /> PHONE <br /> OWNER ADDRESS e: CITY1S7A7E17Ap 'fOn�y <br /> CONT'RA(-rOR - - PHONE <br /> CONTRACTOR AD DRESS CITYISTATF7LIPPTtI�CY I�� <br /> i SUBCONTRACTOR PiaoNE <br /> I SUBCONTRACTOR ADOResa_ CITVISYATEI7AP <br /> ' LI1VN5e -57 0 C-6! 0 D-09 0 Other _ NUMBER_ � ��✓� EXPIRATfOri DATE <br /> I riSa1GRAPHICAL LNFORNATION: Coordinates x ��L -- <br /> Y Township Raogc Sectio,_ <br /> INTENDED USE 0 Domestic/Private D IrrigatintdAgriculturat 0 Industrial 0 Wage(Quality Monitoring },Soil Sampling Cberacterizalion <br /> 0 Public Water Systgll �- <br /> Ifd,fr rfrom Ornery uer n,em.artw; <br /> ariw ur„r ne.urn <br /> TYPFOr'WORK 13 New Well OReplazemenlWell 13W01AlteratitmfModificalion El Test Hole OOther <br /> ❑Monitoring Well(s)_------4ot'wclIs JSoilBoring($).. Xorm'^npvoeryw,ea, <br /> eot3 a <br /> al <br /> O <br /> Wcl[Destruction Q[luf-OrWell [30u1-()f=Service WeN Re=rrewajwa( <br /> I 0 New pump 0 Pu R lacement O Pum R air O Crnss•Connr'tion R it 1 <br /> WELL CONSTRUCTION f <br /> Drilling Method 0 Mud Rotary 0 Air Rotary PkAuger 0 Cable Tool JKPttsh Point 134tbtt ✓; <br /> Proposed Wei( Depth--t-SP—fl Ezcavatior —in diameter El Open Bottom C3 Gravcl Pack/Gravel Size_in n diameter <br /> OConductwCasing_yindiame[er I ConductorCa3in8Deplh R <br /> I Well Casing Diameter in Thicknew(iaugdASTM Sched Cl Steel O Plastic O Stainiesa Steel 13 Other <br /> Grout seal Deplh T- fl ��(� got 1 E3 Send Cement h3 <br /> i p(veal Cement(p1 fh bag/S-!0 !tourer Nwit m&17 gal water <br /> A BrnWnite{2U9k aaliJs) C;Ntaaufacturcr Spur%Solids_T. % Name C3 Spec;Lm File 0 Specs Submined <br /> Grout Placement Method xpuhmxd 0 Free Pall D Other _ O Rdtzrdant/Accelerator(name) ' <br /> PEDESTAL Installed 9 ❑Driller 0 Pulnp C or irac'tor ❑O,lrer <br /> 0 Centrete Pedestal Dimensions: Width__f- Length ft Thick_ in 0 Christy Boi 0 Stove Pipe <br /> Pu.NP 0 Submersible. 0 Turbine 13 Other Hp Pumpet fl SStanding Water Level <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORD(WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE 19 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LJCENSE HOARD AND THAT 1 ANT IN COMPLIANCE WITH ALL <br /> WORKERS CO ENSATION S. <br /> IN] 4 UR ADVANCE NOTICE RE U IRE FOR INSPECTIONS <br /> I SIGNED Tm.r. SJs ' �' y `GreL 1r6AT <br /> _ AT <br /> us <br /> I �-tom- <br /> LZEN _ o <br /> -� 004 <br /> [ AL <br /> MEMT <br /> l P A R T M E V T U S E� N L Y <br /> Applicarion Accepted By <br /> L/ / <br /> Grout Inspection aAreaL�� Emptayee IDN <br /> R Du O SPECIAL Wel!Permit /5 <br /> Pump Inspactior. nate © WAIVER ReceivedDeatrtrctiun{nspcct n ay � .t'•..f -moi- Ua[r: r�7'- <br /> Cvnatrueted Well Depth �-R <br /> COMMF.N 4� �-•" ..K'r yrs tc r,+3• �,,���J/y/� <br /> P£ SC Received Amount Permit/ <br /> Codas Into By Cash Remitted D°Y° Service Request N IPvoice N Well IDA <br /> ;:HO 4}A]dOh <br /> a1E0t WELL PUMP PF:R!r1IT <br />