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WELL/PUMP PERMIT <br /> SAN JOAQ.N COc ENYmDNAHxT.0.f1EALTR DePARTAteNr #1285T • 600E.MeID Street-STOCICION CA 95202 - (209)4684420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FRom DATE ISSUED <br /> Joe ADORPss 99&2 Pezzi Road Crlymm Stockton 95212 <br /> CROSSSTREET Eight Mile Rd APN 089-020 . ,qg <br /> PA¢C2LSQL IAHD USLAPPI.tfAT10HY <br /> OWNER NAA¢ Sohn Bava Peon 931-4730 <br /> OYrnR ADDRTss 12022 E. Comstock Road CMISTATvzrr_- $tockton. CA 95215 <br /> CONHIACTOR Delta Pump JZgx): Peon 202-466-9625 <br /> CONTRACTORADDRess 646 S. California Street Cm/SrA2 - Stockton. CA 95203 <br /> SUBCONTRACTOR Pilot <br /> SUBCONTRACNRADDR CITV/STATFI/.Ir v <br /> LICCNSeOC-57 XXCSI OD-09 OOthcr Ntimsm 724778 E"IRATIONDATe 08/12.. `- <br /> CeocRAPesr.,.[earoruunom Coordi°ata X Y Tow°shlp_ Raage_ SaRuu_ T\ <br /> INSE:rmeDUsr ODomenic/Pmete nigatioNAgncultural- OI°dusriel — Clwater QualityMon7ibdngO Soil Seerpling/Chasectenvsion <br /> "^- O Public Wamr Syystem <br /> 1r4iaawraom Ower: R« yusm .m. <br /> TYPEOPWORR ON.Well O Replacement Well O Well Alterslion/Moditiulion OOther <br /> O Monitoring Wce(s)_If of wells OSoil Boring($) ref,v OOeoteclmiwl - 'ger6wtagr <br /> ❑Out-OfService Well O Out-Of-Service Well Renewal C!Cross-Connection Repair <br /> 13NmPump M Pump Replacement 0 Pump Re air <br /> WELL CONSTRUCTIoH <br /> Drilling Metbod ❑Mud Rumry 0A4 Rotery ❑Auger QCable Tool ❑Push Point OOtbcr <br /> Proposed Well Dcpth - it Excuvalion iudAcnCW 13 Open Bona. 13 Gravel Pink/Greet Size In diameter <br /> ❑Conductor Cesing indiamekr / Conduclur Casing Depth ft <br /> Well Case, Diamcter_ia Thicknas/OaugdASTMSched ❑Sial OPlestic OSUW..Steel 13 Mor <br /> Grout Seal Depth D ONeat Cc..[194 lb hag/S-/0galwumrf E3 Send Cement sack rota/7 gel water <br /> O Benwnite(20Y.solids) O Manufacturer Spee%solids A Ys Nave OSpecson File ❑Specs Submined <br /> Croat Plceemeot M,0od OPumped OFree Pall 13 Other 13Rebodenl/Accelerator <br /> PEDESTAL lmislled By ODriller OPump Contractor CI Other <br /> •OConcrete Ped,.M) Dimensions:Width A Length RThicY is ❑Christ'Boa (3 Stove Pipe <br /> Imm XXSubmerslble OTmbine 0Odler HP 3 Pum Set 150 ft Sisonding Water Level 85 it <br /> 1 HEREBY CERTIFY TIIAT i HAVE PREPARED THIS APPLICATION AND TRAT THE WORK WILL DE DONE IN ACCORDANCE WrM SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS i <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM W COMPLLANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> NI-- UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> StcNeD Tm.e - CEO DATI 04/08/11 <br /> a <br /> 0 <br /> V AL <br /> I <br /> I <br /> DEPARTMENT U E QNLV <br /> Application Accepted By Dna /2/ 7f Area �b Employee lDg X97 <br /> Grout Inspection +" lAm E3 SPECIAL WeH Permit <br /> Pump Inspection Dale O- WAIVERRecelved <br /> I Constructed Well Dept it <br /> CON&RASM - — S �' L62 <br /> l PE SC Received Chs Amount PermiU <br /> odes Moro D Cuh Remitted Dat° Servlee Re .este I°°°I°eg Well Dg <br /> / o as 1 .s- s lPzs7s <br />