Laserfiche WebLink
01/1712001 16 33 2094603433 FIFTH FLOORf PAGE 02 <br /> WELL MP PERMIT (C <br /> (a ; <br /> SAN JOAQUIN COUNTY PUBLIC HEA— "FAVICM F1dYlROTEMPSTTAL)463 364 DIV 1 <br /> 304 I-WEBER AVE,THMD FLOOR STUCk_MN CA 95202 (W91068�� <br /> NON REFUNDAHLEPBIIMIT EXPIRES I YI+ARFAOM DATE ISSUED <br /> RE$S 23sbs So!lam & Rocid -2-41-070 0 l <br /> crEYrap !v e lv A V_ 4S3b_7 PARCEL SIZ <br /> OWNER NAME �q n PCLI� s C ADDRESS. - <br /> cn,rmP cllOn �is3Za PIfONE (zog_ 'R38-7sa�� <br /> CONTRACTOR n- <br /> �:{y 1+fin _wDDREss <br /> CrTYrELP P, a r'�I n-e— 4 97. ONE-( 2 s)3[3 -s$b C-57 MCENSEN 4 S {,S EXP DATE i OG <br /> GEOGRAPHICALINFORMAT[ON COOP-niNATES Y TOWNSLULP s RANGE90 SECTiON .2-q_ <br /> TYPEOF WELL ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# OTHER +'�= • <br /> INSTALLATION ❑WELL SYSTEM REPAIR O CROSS-CONNECT REPA02 ❑VAPOR EXTRACTION WELL t <br /> TYPE OF PUMP ❑NEW ❑REPAIR H P DEPTH PUMP SEF FT FIRSP WATER LEVEL <br /> ❑OUT UF-SERVICE WELL Q OaOTECHNICAL R ❑SOIL BORING DESTRUCTION QM"2— <br /> INTENDED USE ]fr OF WEL(,, CONSTRUCI'K)N SPECTFIC$TLOM <br /> ❑INDUSTRIAL ❑OI'ENBOTTOM WELLExcAVATIONDLt_ CONDLCMRCASTNODLA <br /> ❑DOMBST C PRIVATE ❑GRAVEL PACWSUZE WELL CASINO TYPE WITS'CASING DIA <br /> ❑PUBLICIMUNICIPAL ❑DRIVF_N GROUTSAALDEFIH SPECIFICATION <br /> ❑iRRIGATIDNfAG OTHER GROUT BRAND NAM �n <br /> 1 15- <br /> ❑MONFTORING GROUT SEAL PUMPED ❑YES ❑NO ul <br /> 13 CHRISTY BOX ❑STOVE PIPE { CONCRETE PEDESTAL BY DRILLER ❑YES ❑NO <br /> A['PROXLMATE WELL DEPiTi <br /> V 1 <br /> PROPOSED CONSTRUCTKWDRILLjNOMETHOD M ROTARY AIR RUrARY AUGER �AB1.E OTHF3L <br /> 1 HERESY CERTiTYTilAT 1 HAVE PREPARED THUS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> IOAQl1ITa COUNTY ORDINANCES,STATE LAWS.AND RUL FS AND REGULATIONS I ALSO CERTIFY THATINY G57 LICENSE 45 CURRENT <br /> 0 <br /> JAND ACTIVE Wan THE CALIFORNIA CONTRACTORS STATE TSCBNSL>ISOARD AM THAT 1 AM ITV COMPLIANCE WITH ALL WORKMAN'S <br /> COTHFFAISATION TAWS <br /> _ M1 i+El 4 1 L)IJ11 ADVA NCT,NOTICL RrQUiRI'P FOl2 INST'I-CTIONS <br /> N�+xr—� 5 DATE <br /> SI4NPD - -Tn 0 <br /> r-� <br /> Pf.NCYI <br /> - ` MR <br /> 1t! it Nf3 <br /> owa k U <br /> Ntt 1 <br /> s 1 �dpd <br /> J�� $ 211111 su.[ern� <br /> 11L ` <br /> sAu scrna+ <br /> I P1ICIIC HLl,1t - <br /> Ss<! FIGUX 2 <br /> SFCOR <br /> �3yh5 S ,wt.Mi.ted ri arun nw sett N;W <br /> +^�P°'dH m+awxnw <br /> DErARTMIENT USE ONLY , <br /> Appli=m AmWdd BY <br /> Grout InSpr tm By to 0 d Pump Inspcctod BY N <br /> Inw-t"lnspccU Y 7+l q <br /> ENTS 6 <br /> PE Sc AMOUNT E RECPIVPD <br /> DATE PERMrrlBERVICFREQUEST* INVOICER WELLUIt <br /> DES INFO RfiMII'TED GSH BY ; Co L.4�,"Il P IlJ4iI'z .1 <br /> 373 t <br /> 100 4�Ngk �°1 co "wn <br /> FILE COPY <br />