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#5455 WELL/PUMP PERMIT JAN JOAWIN COUNTY ENVIRONMENTAL HEALTH DEPAREMENT 304EWEBERAVE3-PL-STOCNTONCA95203 -(M)4 420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDREss 5184 W. Highway 12 CC/1un1M�valp Lodi 95242 I 5 APN 05516022 BL- - D CROB4 STREET PARCEL SIE LnrvD UK AP%.KATHsnN OWNERNAMEPrank C. Alegre PHONE 368-7664 OWNERAMAMS H'• Highway 12 clTr/STATE2IP Lodi, CA 95242 CONTIACIOR Delta Stockton Pump PHONE 466-9625 CONTRALTOR ADDRESS 646 S. California Street CMISTATNZIP Stockton, CA 95203 In a� SUBCONTRACTOR Pxgxe Na $UN'OA'fAnCTOR ADDRE59 CeTv/STATEILIP LKFPSE 0C-57 RC-61 00-09 ❑Otho NUMBER 724778 E%PIMTION DAIS GEOORAPHIGL INPoRMATON: CDOTMRaeer % Y TOwnrhlp_ Beer— SRHBn_ \ INTINDEDUBE Domestic/Pnvevmste ❑Imption/Agnookenl 0I-dustriel O Water Qudity Monitoring ❑Soil Sampling(Cherectoriatton ❑P ub�amuaimrm6.nm .m vnmm em. 1-.N—iirPrtANWnWe Tree OFWORK ❑New Well ❑Replacement Well O Well AltelationfModification 0Test Hole ❑Other ❑Monitoring Well(s)_g of Wells 17 Soil Benng(s) ..fbW6M, 0Gmleehni®I xOTxOf1� t` O Well Destruction a outA.Service Well ❑Out-Of-Service Well Renewal ❑New P..p P..p R W.1 D Pettit R it O C.-C....U.0. it WEUCONSTRUCTON Drilling Method 0 Mud RDw,e O Air Roary O Aupr ❑Cable Tool O Push Point ❑Other Proposed Well DepthR Esnvation in diameter ❑Open Bottom O Grovel Peck I Ckewl Sia in diameter ❑ConductorCesing indiameter I Condeewr Casing Depth R Well Csdng Diameter_in Tdckrws✓GaugeASTM Sehcd ❑Slat O PIwic O Swinleee Steel Donner Croat Seal Depth A O Nest Cannot(941b/Me/5-logo/Weser) OSand Cement x«*mE/7p1 Weter O Beenneite OW6 solids) ❑Manufacwrcr$pec°A wlids °/, Name OSpasoe File ❑Spas Submined Growl Phcerceot Method OPumpW OF.Fall [3 Other OReuNant/Acalentor(name) PEDu1 AL IRanlled By ❑Drilla O Pump Canwetor ❑Other O Co..,Pednbl Dlmewions: Width A Lengd ft Thick in O ChdMy Boa ❑Stove Pipe PUMP CESubmcnibk 13 Turbine ❑Other HPPump Set 63 D StoMiog Water Level 20 D I 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 �MIt 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS SIGNED TITLE CEO DATE 03/23/05 G III 111 -411 1 1 P E O D P RTMENT USE ONLY JJ Application Accepted to 7—/J'— �j Qf ^mx 2-17 Employes loft-"" 414 Q Grout InMls on Dewy> � ❑ SPECIAL Well Permit Pump hogwe,'on,By ``'� Date//�fCYQ L ❑ WAIVER ReIYlved Dnnucrion Inspection BY Not Coesteueted Wel Depth ft COMMENTS PE EC Recdasd ChnkM Amount PermlU Ievelced WeII IDK Cerin IN. B a RemlUed Deft ServkeR ualM WELL PUMP PERMR END ,432A PW,.