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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION, OL <br /> 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 <br /> 2 I'� (✓, i��C i"" �AON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED /^ — <br /> JOB✓ADDRESS E . COPPER OF REEVE RD , rPJD BYPON W'Y 2t L--JA k Jl <br /> PARCEL SIZr1i r P- npv <br /> E/APN CITY/ZIP T R A C Y <br /> I 111111l <br /> OWNER NAME S�'r, DZ77 ADDRESS 1832 PF•RADISE VALLEY CT . <br /> CITY/ZIP Tf)ACY , CA 0,537,5 PHONE 833-0813 <br /> CONTRACTOR HEI11'IN-5 BROS. DPILLINADDRESs 3525 PELAP PALE AVE . PAY F=T T— <br /> CITY/ZIP r10DEST0 , CA 95356 PHONE 5t-5- 1185 RECEIVED <br /> MAY <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION 0 <br /> TYPE OF WELL: OX NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# �UIN COUNTY <br /> ENVIRONMENTAL HEALTH DIV15ION <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW ❑REPAIR H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA 12„ CONDUCTOR CASING DIA <br /> - <br /> 0 DOMESTIC PRIVATE `h GRAVEL PACK/SIZE WELL CASING TYPE P V C WELL CASING DIA 6 <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUT SEAL DEPTH 10 0 t SPECIFICATION B@ntOnito <br /> ❑IRRIGATION/AG OTHER GROUT BRAND NAME B A R I O I D <br /> ❑MONITORING GROUT SEAL PUMPED: Xl YES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: ❑YES 7 NO <br /> APPROXIMATE WELL DEPTH ' <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY X AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND RE ULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: <br /> TITLE: SUPERVISOR, DATE: MAY 1 2001 <br /> n <br /> 00 <br /> _ NLY t7 <br /> Application Accepted By Date ( u _Area 2 <br /> Grout Inspection By <br /> Date Pump Inspected By Date <br /> Grout Inspection By.56wo <br /> Destruction Inspection By Date <br /> COMMENTS: <br /> PE SC AMOUNT CHECK#/ RECEIVED DATE PERMIT/SERVICE REQUEST# WELL ID# <br /> CODES INFO REMITrEQ CASH BY <br />