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WELL/PUMP PERMIT <br /> SAN JOAQUIN COmvry ENY®IXiNlENTAL REAi,r DEPARTMENT 610997 600 E.Main Strea-McKr'oN CA 95202-(309)468-3420 v <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED f� <br /> Joe ADDRESS 9982 Pezzi Road CITY01w Stockton 95212 e� <br /> CROSS Brneer Eight Mile Road APN 089-020-52 PAS%=sat LAND USE APPLI[wTIONp <br /> Owteea NA ' John Bava Family Partnership PHONE 931-4730 <br /> OWNERAopasss 12022 E. Comstock Road Crsv/sTATErze Stockton, CA 95215 <br /> Core i:yoR Delta Pump PHONE 209-466-9625 <br /> Com'RACIoa ADORERS 646 S. California Street CIT'/.STATE2R Stockton CA 95203 <br /> SuscowiRACrOa <br /> PHONE <br /> SUBCONTRACTOR ADDRESS CMISTATEJjP <br /> LICENSE 0657 L.E661 0D-09 13 Other NUAmER 724778 E% Tltxli DATE 08/10 <br /> GEOGaAPI11CALINTDRKATION; Coordinates % Y Towmhip_ Boost_ Sectloo_ <br /> 1_NIErnEyuE ®Donwslic/Priak ❑Irrigetion/Agriculunl Oindumial ❑Water Qudiiy Monkoring ❑Soil Samphoschmcterimion <br /> ❑Public Water gystem <br /> IfGBem,6m Ow'eer ue Yum a ueun amtar a um (�' <br /> Tvn OFWORK ❑New Well ❑ReplacemeM Well ❑Well AlteratiONModificatbv ❑Other <br /> ❑Moeiwring Well(,)_Mof wclb ❑SoSBoriog(s) sOfaO"esa 0Gemclurial aofbwkVa <br /> 0oa-0fService Well ❑Out-Of:Servke Well Renewal ❑CmssConawdon Repair <br /> ❑New Pump It Purrut,Replacement ❑ 4 <br /> Wet. ONsrn rnoN <br /> Drilling Maned ❑Mud Rotary ❑AORotary, ❑Auger QCable Tool 13 Push Point ❑Other <br /> Proposed WeB Depth B Excavation in diameter ❑Open Bottom ❑Gravel Peck/Grant Size In diameter <br /> ❑C04doaor Cuivg ivdiemeter / Cmdumo,Cabig Depth ft <br /> Wdl Cmat Diameter_in Thkknea/Gaute/ASTM Sched ❑Steel ❑Plan, ❑Stemless Slee] ❑other <br /> Groot Sea Deptb a ❑Naf Cmcw(P41bbog/d-l0ga/wmer) 13 Send Cement reedmtr/78biwater <br /> ❑Hacienda(20%wlids) ❑Mmuf cwM Spec%miida_% Name ❑Spas oa F0e ❑Spas SubmiOed <br /> Groat Oacemnt Mtlbod ❑Pumped ❑Free Pdl ❑other ❑Retardant/Aecelmmr(vame) <br /> PSPYFfAL Installed By ❑Drilla OPtmp COotream O Other <br /> ❑Cootate Pedea4l Dlmeodons:W1dfh a Lengthft Thick in ❑ChristyBos ❑Siwe Pi <br /> pt <br /> RSSubowrsibk ❑rLrbine ❑Other F@ 1 P Ser 50 fl SteMi Weser Ind 106 It <br /> 1 HEREBY CERTIFY THAT 1 RAVE 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 /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL I - <br /> WORKERS COMPENSATION J,AW { <br /> •..�-�-MINIM M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNER Tr= CEO DATE 611,1 / <br /> 1 41 - 111RC wjE <br /> EP RTMENT US O�,N LY -(�//�� <br /> Application Amixed B Date /,f Area Employee ID# <br /> Growinspectiov8 Date ❑ SPF,CfAL WCR Permit <br /> Pump Inspection Dae `� ❑ WArvER Received <br /> C0oslroeted W ell Det D <br /> coMMENrs /7- Y — -.�o � si�eie <br /> — <br /> PE SC Received Cheddl Amount Permit/ <br /> Coda lore B Cash emitted Date ServittR until lovalttp WNI mil <br /> R+C� r— 1 b 5'd <br />