Laserfiche WebLink
' OWNER NAME ADDKGNS__��+*-�.'=— -- <br /> CITY(7[P_- Yom' PHONE__— <br /> CONTRACTOR ��.t+�+�C=__ADDRESS_jaz _ <br /> ' CITY(/.IP= .S 3 PHONF_ � <br /> ' GEOGRAPHICAL INFORMATION: COORDINATES X__ YTOWNSHIP_ RANGE.__ SECTION_ — <br /> TYPEOF WELL: ❑ NEW WELT. ❑ REPLACEMENT WTLI, ❑ MONITORING WELL O— ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECTRLPAIR O VAPOR E•X'I'RACI'ION WELL#_ <br /> I <br /> 'TYPE OF PUMP: ❑ NEW ❑R AIR ILP. DEPT[I PUMP SET- 07 _FT. FIRSTWATER LEVEL _ <br /> ❑O -OF-SERVICE WELL ❑ iEOF OTh:CRNNLCALY— ❑SOIL BORING -_ ❑DFSTRUCTION: <br /> ' INTENDED USE TYPE OF'WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA__ CONDUCTOR CASING DIA, <br /> lKDOME.STIC PRIVATE ❑(TRAVEL PAMS12F.__ WF:I.L CANINGTYPE WFLLCASINGDIA <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUT SEAL DEPTH SPC-CIFICKRON <br /> ' ❑IRRIGATION/AG OTHER GROUT BRAND NAME <br /> ❑MONITORING GROAT SPAT.PUMPED: ❑YES ❑NO <br /> ' ❑CHRISTY BOX ❑STOVE PIPE - CONCR:-.TE PEDFS'TAL RY DRD.LER: ❑YEN ❑NO <br /> APPROXIMATE WELL DEPTH U _ �— <br /> ' PROPOSED CONSTRUC'r10NIDRILLING METHOD: MUU ROTARY__ALR 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 ORD[ LACES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQIIIN COUNTY. <br /> ' SIGNED: <br /> TITLE:_ <br /> —r <br /> T T , t <br /> 1impsR(TNium USE D <br /> Application Accepted Ay_ � C " � are_ / l'' Area /• <br /> Grout Inspcctiun By___ Dalc__Pump Inspected Dne�ra � <br /> Desinsiion Inspection By <br /> ' COMMENTS:___ ._ __— <br />