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WELL/PUMP PERMIT <br /> SAN JOAOMN COVNiV ENVIRONMENTAL HEAITN DEPARTMENT 6OOEAS1111AiNSTREET STOCnfONCA95202 12091468.7420 <br /> NDN-REFUNDABLE PERMIT CALCI[ 091953.2997 FOR INSPECTIONS__- _EXPIRES i YEAR FROM.DATE ISSUED <br /> Jos AcORNIM, <br /> Givl2m P <br /> C��9TgME ��///��,E�E/s//Fl�^(�'. ! <br /> \�M�/�• APN I 0 CiARcrl SNf LAND USE n 1LA•1nNe/ <br /> ' OWxEq AOMaSk.JS�CY_L�SIIi�ffliya4`�y1A4-"'� CIT-r_IIS.-iA.-r. lzlP <br /> FFq _-e;--PP�bHX_OON-`EICONTACTOR FE _Pon <br /> ��_�(rTr <br /> i.Jce�—}( <br /> ICOMROADMESSE�� CTYS6 / <br /> II <br /> _ <br /> SVECONTNACIOR ____ __ __ _ -_. PHONE _ <br /> SVBCOVTRALTOR AOOgEsa _.._ <br /> f S'• T 20 it <br /> ' IPCS) [-61 9 OIOe — NVMBEUCExaF X863 ATON De if �J <br /> GEOORfPH1UL INFORMATION; CoOfAlOfla! V .0 TOwnehlp Range •_� $OCiMn_ <br /> INRNO(D USE I Dome5liLJPnvp' kumilural Irt(oI WafC100aM1ly Mnmgnnq $OII SemplmglCneraClenLOUOn <br /> ' Public Weterfivsm - <br /> NdttVSM er se�PW wI � --o.• o <br /> TYPe Or Woag New We9 Replacemem well well NternuoNMPOTcauon Other <br /> •etnwps -- eel eonno�.-__._._ <br /> r <br /> Monitoring Well(s)_ a of wells Spn Aorgiglsl Geolecnrvcai I <br /> OVi.Of-S.'Ice• rml Out.01-Sewirp Well Renewal Cmss Connacnoo Fell -- <br /> ' Naw Pvrn� u a lecemenl Pu Re pn _ Raise Well Casln <br /> p'" M' .-P-----�_n9P__--- '__.....--9----- <br /> MieLL toxaTaucnaf " <br /> Drilling Method Wd Rd Air Rotary AvOei conte 1001 Push Pont Other <br /> PmpONd Well DePO It ETcavellOn —,.— mMamelat OOen SonOm Grovel PaCklGrevel Sae in demote, <br /> ' f Condudo=CCn5ing— e miw <br /> +niaeCOoLIC10:Casui9 Depth_ ___- -,fl <br /> Well Casing Diameter Tnicknesa/GeugO/ASTM SLned Sorel PlasticSlamlese Steel . Omei <br /> Grout Seel Deptn 1t Neal Comem(94 to ne9/5 IU go,ureter) Send Comm _sack moll gel wider <br /> L Bentonite(20%solids) <br /> IDrmd Placers l Method r,Pumped Free Fell ,Other —__ Reladam j Acc W,,.c,Inamel_ --_-- -- ' <br /> �E ,�k Installed 9y 1 DHllef 'Pump COnlreclol Omei_ � <br /> , Dncmte Patlasfal DlmenElonS Width h lenggi R TRLk _m Chdity 80y O Stove Plpa <br /> _�' i01e ,. Turbine l Olhel HP Pump Scl__.__ 11 Standing Water Level 11,1 <br /> P SvD <br /> ' I HE;.2 G'�';'^T�THAT I HAVE PREPARED THI$ APPLICAT'ON ANO TMA' TNT. WORK Wlll BE DONE IN ACCORDANCE Wulf SAN <br /> !OAOUIiIt,� OROINANC ES. STgTE LAW$. ANU RULE$ pNU REGVLA iiy+J ALSO CEnii:t THAT td't REOViREO uCENSE IS f <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPL'ANCE WITH AL1. f1 <br /> WORKERS COMPEN'SAVON LAWS <br /> SroNeo o -4_HOUR ADVANCE iECE REQUIRED INSPECTIONSJKLIVD <br /> A AW <br /> � . . . . . . , ; 1j- ,. . <br /> ' VI�ED� <br /> a�4 4T <br /> - rA,1 t���0 E n n P ' v C N t VSE r�0 N/L Y /I� <br /> ApplNawn ACCePIed AY /✓ l f\le' ta_t� _ bila_:,�._2 (3, Nan_._0;/.�05 —d.yt.iDa AQCE <br /> ' <br /> Groot mapedron Ay Dnic ---.A <br /> SPECIAL Well Permit <br /> Pump ma BV -._ Ueln J //9 WAVER RBCOIVetl <br /> D IC r LF• rO isvuc Oo Wall Depth n <br /> 9w Bodnq i ion BY '`yy,� _—. — <br /> COMMENTS <br /> PE SC ROCRIYad hoc Ampunl --r ParmlV i <br /> Coda Info Dete in ocee Wan lOe <br /> al Remltl��._ Service Request e� <br /> 3(,-7X, __�Skv_obbg2y - — <br />