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WELL/PUMP PERMIT <br /> SAN JOAQOIN COUNr9 ENVnt0.NAD'MAL REAI.Tn DEPARTa6NT #13117 600 E.Main Street-ST0cXrON CA$5202 - (209)468-3420 <br /> NONREFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECIIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRWS 537 W. Yettner Lane CTwrrLw�FrencheCamp 95231 <br /> CROSS STREET Manthey APN//.�W�W PARtILs�' LArm USLArPuunonN <br /> OWNERNAME Nick Ratto Poon 982-5686 GG <br /> OWNER ADDRESS Same CMVrATX/Z1P <br /> CONTRAcroe Delta Pump Pnon 209-466-9625 <br /> CommAc RADDRree 646 S. California Street CTn'/STATE/ZIP Stockton. CA 95203 <br /> SOeCONrRAP OR PILON[ <br /> • $UBCONTMCfOR ADDRESS CM/$TATE/ZR <br /> UCPNse 0C-57 XZCbI 0D-09 ❑Otlter NllatgeR 724778 EWIAATION DATE08/12- <br /> j GEDGRAPmGLIM lssu[ATION: Caordlnate. X V Towmblp_ Be.,,_ Section_ <br /> INIENDEB USE 0 DommdryPrivate ❑IOigstioNAgdwltunl ❑IndGtrial O Water Quality Monitoring ❑Soil SunDling/ChencmriTuion I <br /> ❑Pwblic WYICrS tem <br /> varremt0e O— Wa.S.. .mt ween <br /> TvrEOv WOR¢ 13 N.Well ❑Replacement Well O WeII Alterman Modi6Gtion 13 Other <br /> QMonitoring W<II(s)_Yof wcib E3 Soil Boring(.) Yefbotiap QOCoteehoiGl Yefhadoge <br /> ❑Out-Of-Service Well ❑Out-OGServke Well Renewal OCrws-Comleclion Repair <br /> C1 Nm Furulp 119 Perri,Replacement 0 Puny Repair <br /> WELL.CONmucnon <br /> Drilling Method 13 Mud Rotary 13 Air Rotary ❑Auger QCable Tool QPush Point ❑Other <br /> Proposed Well DepthR Excavadion in di,.w Cl Open Bottom C)Grant Pack/Oravei Site )n dluneler <br /> ❑Cooduceur Casing indiuneter. / Coaductur Casblg Depth R <br /> Well CaadOt biemeicr u ThkkmsvGmga/ASTM SOM1ed OSWI 13 Plastic 0StaioleG Steel C)Occur <br /> Crows Sea) Depth A Cl West Cemenl(9Nb best/5-/Oga/worry) Cl Send Cunent sack mte/7 gel water e� <br /> ❑Beranek(20%solids) ❑Mru ufKwrcr Spcc%solids_% Name Q Spee on File O Specs Submitted r_f <br /> Grout PlacemeOt Method QPumped OFree Fall C3 Other 0 Retardant/Accelerator <br /> pgyESrAL Iuualied By 17 Driller ❑Pump Contractor ❑ Other V <br /> • Q Concrete Pedestal Dimensions:Width fl Len RThick in C3 Christy Be. ❑Stove Pipe <br /> )Wubmmsible ❑TLrbue ❑Other HP 135 Puree See 62 ftSt.di.$ Waders. --aL_fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RALES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH TBE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL rA <br /> WORKERS COMPENSATION LAWS <br /> IMM M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS \ <br /> SlctrEq TTnE CEO DATE 04/29/11 r� <br /> \tl <br /> AW-RT <br /> q!ECENOD <br /> I <br /> 0 <br /> so ul 'Cr,n, <br /> *x ter r: <br /> DEPARTMENT USE ONLY <br /> Application Led By aG; Date / Arca Employ.1DY <br /> Grout In y Data O SPECIAL WCH Permit <br /> Pump Inspection Date 0 WAIVERRecelved <br /> Cooadr el,d Well Dep R <br /> COMMENT'S �f%/.I/-Y SbIL reT/raj '//rryL��fL( .�d�� s4-lcE7! /4.'fJEfY� � <br /> =4C <br /> PE SC Received AmaRul Date Ptrml✓ fovaleeN WeII IDN <br /> Steel"Ae uu1M <br /> Codes la 10 By Cash Remitted <br /> / 030 �l4 / 200 <br />