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WELL/PUMP PERMIT RANJOAQIIIN COUMT ENVIRONMENTAL HEALTIt DF.PARTMEw3e4EWEVXRAVE3e"FL-S1rOCKTONCA952B2 -(209)4dd-2420 NON-REFUNDABLE PERMIT CALL 209 9517697 FOR INSPECTIONS EXPPII,R/ES�1 YEAR FROM DATE ISSUED JOa ADDRE56 59.�o KJnQd�hJt Road '�J1�r Crrr2II1}�Y L CR MEET APN F1 •' _ 14'.e � '1 //�P�AIRg11.`)1. Z7e• 'J(U OWYERNAME �� / / PIIONIg 21- )_%?-411Pd'L�b OWHP.R ADDA65�3�f /J�/y y- ( / 11�n CI'M/STATV21Y a a- ColEr.cTDR PV tST L{Jf{�c/ V ��n `j` G C-fi R PHQNE 3fOO 3/3 k3 r< COATMCI00.ADDREW 9'l�Y�. /'IifJ ISI-Z.Of-Ils� CITY/STATil/JP 1ej b- psa yG SuscoNTRAc aAj O1 P1n E SWKMWALTORADUREE3A)j 0— CTYWTTU2JPry M ucENEE 0 C4 IPa61 13 D49 oanV(110exIIMITI DDATE I � 10 GROCIIAPHICALINFORatAnON: CeanfifIRn X Y Tnwmbip Revge g Ion_ INTENDED USFDWn.ridPllvate ❑IOfpnon/Agnculwmnl O Induid E3Water Quality Monitoring 13mp Soil Snling/Ch irnza4on D P blie WE.,mnO.t.e "wr yuem arae -2m�� o iIra Rn fr in un i TYPEOF WORE D New W<II ❑It'licnneni Wdl ❑WNI ADcNtioNModifi lira O Tal Hvk D(nIlkr D Monitpnng Wdl(s)_ n"neer er..ny OSoil Borm U) °"mbn erevrinB. ❑Gmkehmcel nunbnefbnngt ❑WNI Dnhucdm ❑Oul-OFServke Well OOnI-0f-Service Well Renewal New Mm D Pum Replacement ❑Pum D C.CUnncrdm R WELL CONSTRUCTION Drllliog Willed ❑Mud Rotary ❑Air Rner/ ❑Auger DCablr Tool DPush Pint ❑Other t Prppmed Well Depth 11 Esmyatinn in dt..n,r DOpm BNwm D GNvel Paek!(invN Sim udlanow ❑Conductor Casing indiameln / C.mJ.tm Casing Depth It Well CaYng Diamner_in Thieknms/G.,dASTM Sd%cd D SkN ❑Plrsdc D Slaw.Sl l ❑ONm Grmd Sed Dep& B D Neat Cemem 04 Ib bag/J-IOgal mater) D Send Cemcm rack mal7 gal water ❑BemoNle(20%meds) ❑Mmuficw.S,.% lids_% Name ❑Spm ml File ❑Specs Submiued Cmut PW*.nt Method DPumped ❑Free Fall ❑Othm DReWdut/Accel..(name) pmLTrA Intdkd By Cl Dnller ❑Pump Cmua w Cl Other O Concrete Pedestal Dimeadms: Width it lengthR Thick in ❑LLrkry Boy ❑Steve Fume )(Submersible ❑Turbim Cloth.,- HP Pump SetI_ft Stmding Water Level� n WELL DFWRUCraON D Open BMrom ❑G.d Peck ❑Unmsed ❑Other Well Diameserin Tom)Depth D Ikmhm Waw ft DCuingbbe PerforaKd from Rw_R Seding MskdsCemm l ❑Nmt t(94 lb bug 15-IO gut wmer) O SzW Cmsens smt mh 17 gal wler ❑&m nice Pelleu ❑Bemm.ile(20I4 muds) ❑Manu Sourer Spec Yesolids_% Name ❑Speeson Fik ❑Specs SubmlFed Placemen[MUhod D Pumped ❑Frrs Fall O Other ❑Compkw With Mushroom Cap tl below grade D Canpkle m Esiaing Surface Pad 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. 1 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. ADVANCE NOTICE�RJEQW'RE'D FOR INSPECTIONS 0 2 9rnnxD_ __-C•VS -� � Tm.e .�7�Ee`� ATE� C/L LE A p n DEPARTMENT USE ONLY A,li"Win Accepted 8y �.v".aV/`A�' Date 9 --0 - Arca_ Enn,ln mIM Ibyq G.I:m tfpn By Da¢ 13SPECIAL Well PVllllt Pump nspmdun By DMe / g 2 ❑ WAIVER Received De9.ImR lnapcvti$9^�By Date Cvnstrmled WeH DepM�_ fl COMMENTS JLa.1L0 OZ PE I SC Amount h / Rmeived Dafe Prrmit/ Invnkep WNI IDp CWu I.T. R.W,,d .11, B ServkeR met) END43-02-OO6 MASTER WATER WELL PERMIT snn_om