Laserfiche WebLink
II YN <br /> a, ,, WELL/PUMP PERMIT%OGKIT� ARfLf�CEO <br /> SAN JOAQUIN COUNTY ENVIRONMENTALTRL DEPARTMENT 304E EEERAVE3- ,-v, CA 93202-It")/6"M <br /> NON-REFUNDAB <br /> BLLE <br /> nPEERMIT CAI.L(209)953-7697 FOR INSPEITIONS EXPIRES VEAgR FROM DATE ISSUED <br /> JOB ADO SDt�S• J�E-7LT CrtY2D ��CdOZ N� /SI�-o Cb <br /> CROnSnggT 4,e u{ F-r APN l77-7L0-?-6 PARCEL SVIi Sj LAmUS1AMLICAT10n0 a <br /> OWNCR NAME 4fbc97LI.1 MFTF pnntl TP1,t.J AIrz,pt-,IcT— PHOnE M <br /> OWnrI AMNA. f may' ,.I CHY/SAT P <br /> COMRACrOR KLi'7I�U !/i✓c�/�l�/I,/�.�,'Cr. <br /> CONTRACTOR AOORG/B�,AK��Jt"J �. VH ISG 7L • CRV/STATI'/ZZIP � cA 9s mor <br /> BUBLONI (7omt PRONE <br /> SUBC'ONrNACTOR ADDRE83 CRY/STATIUZIZIP <br /> 1.1cla E -57 O Cfil O D 9 O Otho NUN RJ T EXZTION DATE d <br /> G800RAPQCALINPDRMAT ; Coordinate. % V Tawnhlp_ Range_ SAO..— <br /> INTENceD UM: O Daneaic/Private D IaigatiuNAgncultuNl O Indushiel O Water Quality Monitonug it Sempling/Chara unOaiml <br /> O Public Wau, Syn tem <br /> nuilrumt avmO .Dn .m.w <br /> TYPEOPWOER ONew Well O Rcplxement Weil O Well AltautioNModificPnon 13 Test Hole OOther <br /> OMonitoringwell(.) kofwells ❑Soil Bonog(s) "'Con'a �Cxavchniul a°rE°n"p <br /> ❑well Deswcnon OOutd&Service Well OOut-Of--Scrviu Well Renewal <br /> O New Point, O Purn,Replic., O PUmp Re,xtir O Cotat Conation Rvair <br /> WELL CONBrRUCDON <br /> Drilling Method O Mud Rotor, O Air Rout, __-H'Au O Cable Tool O Ptah Point O Othcr <br /> Propored Well Depth ft Ewnlim" in diameter ❑Open Bottom ❑OravN Pack/Gavel Sim i.dlamncr <br /> O Conductor Caving in diaumn. / Cooductor Casing DNth ft <br /> Well C.dne Ouniner_in Tbickna/G.uge/ASTM Schur OSlccl OPIMIic OSYinha Steel OOth. <br /> Grout Seal Depol It ONat Cement(94/b bog/5-IOgd water) I75aM Cement raoAnvr/7galwat. <br /> O Bentonite(20%solid.) O Manuf,oUU,n Spa%.ltde_% Name O Specs on Fill O Spas Submiucd <br /> Grout Placement Method OPUrnped OFra Fall ❑Otho ❑Rererdant/Amelnata(Tome) <br /> PEDMAL Installed By O Drill. O Pump Contncmr ❑qnn p <br /> O Concrete Pedestal Dimeado..: Width —ft Length_fl Thick in O Chrl.ty Boa O SAN"Pipe D <br /> PUMP 0SubmenibIn 0Turbine OOtha HP Pump Sot ft Studing Water Level fl J <br /> W L DrsrRUrnON O Open 9otmm O GRvel Pack 13 Uri.o O Other ..EL <br /> Well DiMnner n Total Depth ft Depthto Water R OCaningtobe Perforatedfrom_BM R -'A <br /> Se.ling Material O Nat Cement(9e/A bag/5-10 gut nater) O Sand Cement_rock Mie/7 gel wawamnJAI anniM PdlEte may°f <br /> O Bito(2� O <br /> .lid.) M.Ufatumr Spa%ADiids % NMne fiSpason File O4prra Sdbmitmd <br /> Placement Method O Pumped O FRe FPII Cl OdNT O <br /> O Canplete with M.A.Gp flbelow grWe O Complete to EAialing Surface Pad <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN V <br /> JOAQUIN COUNTY ORDINANCES.STATE LAWS,AND RULES AND REGULATION& 1 ALSO CERTIFY THAT MY REQUIRED LICENSE is I <br /> CURRENT ND ACTIVE WI 1 TIH CALIP NIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKS MPENSATIO Wf. <br /> 1 1 UM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGN= r Tins �TA'Ff GA.(a•a,`.�P"Z DATE 6 to O <br /> 4:� A <br /> yin{; 1` F J O I <br /> 51 N O N <br /> ' J <br /> d mu"f <br /> P DEPARTMENITU O V - <br /> Applicenon Acc"BY Date L O Ara �/� Emplo AM IDI - <br /> Grout mapation By Date O SPECIAL Well Permit /49 <br /> �� P//umy�p�mapcclion By Da¢ 13 WAivER Recelved <br /> q�� <br /> nirm 'Ins,ectin B / (i• Dam �Y9��.e GnWuet NIWell Dept. ft <br /> COMMENTS OL% rtk L_ae.e-- L�.A L u +-SP� x L-'kA1 w"'f'LL c ilr�e f P yy a,,e. <br /> r.A � <br /> J <br /> PE SC Raeived Checke An.unt P. <br /> Coda Inh M It Remined Date SN,1E, Eat# Inwioeg Well IDB <br /> 3.11 /SQ 11 Iaa3(o a-sD.vo T 'D (too 39 I <br /> EHD,042 OM1 -5 —i) <br /> ' _ I MABTER WATpt WELL 1ERMR <br /> - i( <br />