Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JO Q�IN E.WEIIER AVE,TH RD AFLOOR STOCKTON CA 92()2 (-09AL HEALTH46R- 0rv(S1U <br /> NON-RFFUNDABLE PERMIT PiRN:S 1 YEAR FROM DATE ISSUED <br /> o _ <br /> Tell <br /> 10B ADDRESS <br /> t - _ <br /> CITYn.IP <br /> �- <br /> OWNER NAME <br /> CLTY/ZIP_ �h� jA <br /> CONTRACTOR - —ADDRESS�j _C—'S7 L—ICEN—SE#4Q��G-EXP—UAT-99-1 <br /> — <br /> CITY2IPkwQ <br /> TOWNS[IIP RANGE_— SECTION _-- <br /> CEO(;RAYtIi(:AL INFORMATION: COORDINATES J( Y-— L -- <br /> 'TYPE OF WELL: KNEW WELL_ ❑ REPLACEMENT WELL t] MONITORING WELL#�— <br /> _O OTHER <br /> INSTALLATION: ❑WELI.SYSTEM REPAIR ❑CROSS-CONNEC'i'REPAIR ❑VAPOR EXTRACTION FIRST WATER LEVEL---- <br /> DF.VrH PUyIP SET r- <br /> TYPF.OF PUMP: [3 NEW ❑REPAIR H.P.- — ❑SOII.IIORING C1 DESTRUCTION:- <br /> ❑OUT-OF-SERVICE WELL E3GEOTECHNICAL#- _ C N ,R t .T'1 N S 'C CATION <br /> "1 • '{)F U ^ CONDUCTOR CASING DIA-- <br /> ❑OPEN BOTTOM WELL EXCAVATION DIA - <br /> ❑INDUSTRIALWELL CASING DIA <br /> *RAVEL PACKISI7E--- WELL CASING"TYPE, -�- <br /> --- <br /> I3 DOMESTIC PRIVATE �" -_-- <br /> �LJHLICJMIJNICU'AL d DRIVEN <br /> GROUT SEAL pEPTf 1��- SPEC{IICATION �/3s <br /> ( ER GR UT BRAND NAME fes►—ji <br /> ❑IRRIGATION/AG /�'3 C t � �RM Cl>c�e- <br /> 0 <br /> A ❑NO , <br /> GROUT SEA PUMPF.I): <br /> ❑MONITORING � <br /> CONCRETE PEDESTAL HY DR[LLER: ❑YES NO <br /> ❑C:HRISTY BOX C)STOVE PIPE. , <br /> APPROXIMATE WELLDEPT'H ----- �/ <br /> l�.AIR ROTARY _AUGER—__CABLE..—_ (71TlER-- <br /> PROPOSED CONSTRUCTIONMR[L LING METHOD: MUD ROTARY_— <br /> LAWS,AND RULES AND REGULATIONS- I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRF.N'C <br /> I HEREBY CERTIFYTHAT HAT I HAVE PRPARED TINS APPLICATION AND THAT THE VN'ORK WILL BE DONE IN ACCORDANCE WIT'11 SAN <br /> JOAQULN COUNTY ORDINANCES,STATE <br /> AND ACTIVE WITH THECALIFORNIA CON I RACTOR.0 STCIPE COMPENSATION LAWS nD T1{AT I AM 1N COS1Pt.tANCE WITH ALL WORKMAN' <br /> MINIMUM 24 HOUR ADVANCE NOTICE RE,QUIREll�FINSPECTIONS <br /> FOR E 6-- <br /> DAT ?t <br /> SIGNFD�SC —Z <br /> E - - <br /> cob <br /> T E ON[,Y <br /> DEP D <br /> ''ME <br /> USE <br /> Application Accepted Hy <br /> 13167N Dale:� O� Arca_ �ISL -.EMPiT?M �D 30 <br /> I —Date <br /> Grout Inspection By <br /> Date _Pump Inspected Hy <br /> { --- Date . <br /> 11 1 7t.on Inspection By <br /> — <br /> Ell TS: " Ell J�1 A11 µ,Pcf 5*fF .'t a y)-t4b V)A--- <br /> f PF SC' AMOUNT (:HEC RECEIVED DATE PERMIT/SERVICCREQUESTS INVOICE# WELL ID# <br /> CODES INFO REM D SH BY <br /> 3 3 12x96 <br /> s , <br /> �� D ✓t�`�R-y nt rwT � �� <br />