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WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> �j 104E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)468-3620 �703 -4 30 4 <br /> 12q F� w NN-T^J��[�7y/y',','ABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 10B ADDRESS %ki MMY- -SM-fi batT az ,41 lal � <br /> r <br /> c[rymp-Gr +-I TC?4�_w<a .% PARCR(StM <br /> OWNER N.AMFApPUL�O LA76 TL'4a..'>71DSJADDRESS 17.0• 3—J< <br /> crrr��Rza6 Tt Nl to - r c e r -7 4 i T5 PxoNe F Yo" 3 ^5 C-79 <br /> CON'IRACTOR�P� f7.CVrrnc.Si...r ,q�bGi ADDRESS f7. �ia�5-�s✓ Lu P <br /> QIY/aP L.VP ALF a 5 4� > FHONETa77o1 C•57 lJCENSP 6U Z— DATPA/Q; <br /> GEOGRAPIUCALINFURMATION:COORDINATES X Y_TOWNS_ RANGE_SECTION / <br /> TYPEOFWELL: D NEWWELL D REPLACEMENTWELL Cl MONIIORNG WELL# ❑OTHER <br /> INSTALLATION: DWELL SYSTEM REPAIR D CROSSCONNECT REPAIR ❑VAPOREXTRACHONWBLL# <br /> TYPEOFFUMP. 13N9%? ❑REPAIR H.P. DEPTH� PUMPSET FT. FIRST WATER LEVEL <br /> D OUT-OPSfiRV[CE WELL ❑GROTECHNICAL# •111�SOIL BORING ❑DPSTRUCHON: <br /> '!TIDLL$ED USE TYPEOFWF.LL �1 ONSM NSFRCWI ATION <br /> D INDUSTRIAL D OPEN BOTTOM WELL EXCAVATION DrAJFF—, — CONDUCTOR CASINO DIA_ <br /> D DOMESTIC PRIVATE DGRAVELPACKISIZB_ WELLCASINGTYPE WELLCASINGDIA <br /> D PUBOCIMUNIC[PAL 0DRIVEN GROUTSEALDEPOI SPECIFICATON <br /> D IRRIGATION/AG OTHER GROUT BRAND NAME <br /> O MONITORING GROUT SEAL PUMPED: DYES 10 <br /> D CHRISTY BOX D STOVE PIPE CONCRETE PEDESTAL BY DRILQR: DYES t7F10 <br /> 1 <br /> APPROXIMATE WELLDEPTH ( j3�-D <br /> PROPOSED CONSIRUCIION/DRBLNG METHOD: MUD ROTARY—AIR ROTARY__AUGER CABLE_ OTHER_ <br /> I HEREBY CERTM THAT I(RAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES ANDREGULATIONS. I ALSO CERTEFY THATMY CMT LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAMS <br /> COMPENSATION LAWS. <br /> MINI HOUR ADVANCE NOTICE REQUIRED IFOR INSPECTIONS <br /> SIGNED-��-''• •TD�',Y. I ('r-IEi'P-N DA I 1-7 <br /> Nr <br /> ji <br /> • �J S �c� c <br /> 1L <br /> o ter`. <br /> uc <br /> 7A HE <br /> DlPAATBffiVf USE ONLY <br /> Apphmtim A H Dm I`AF 02—A, 2.1R �aemr.f3h6 <br /> 0.1 lusptetim By R Pue,p Iwpaud By Dole <br /> Deouctim wpetim Byez;2�ofi <br /> COMMENTS: <br /> PE SC AMOUNT CHBC RECEIVED DATE INVORCON WELL m# <br /> CODES INPO RHMTIED H BY <br /> 72 o 7i7�oaq t6 <br />