Laserfiche WebLink
jo r zhb <br /> • WEdIPUMP PERMIT <br /> SAN JOAQUIN COUNtY ENVIROlaIENTAL HEALTH DEPARTMEM 1868 EAST HAMMN AMUS-STOCICTO N CA 95205-(208)488-9420 <br /> NON-RMNDABLE PERMIT CALL 209 953-76%7 FOR:1NSPE EXPIRES 1 YEAR FROM DATE ISSUED <br /> jJea Aotatess ARNCRYmP <br /> '� 0 O PARCEL.SRE D USE,APPLICATION# <br /> CROss STREETMir <br /> rn <br /> =NAM. O I NONE f�f 1 Y <br /> OwtaeR <br /> '� CITY/STA `-`A <br /> CONrRActaM � V <br /> jlJO/N f� � `+ <br /> CONTRACTOR ADORES <br /> ! <br /> V � ! �� A PL t/t+ � ( <br /> 1SURCONT .. Pttot+t <br /> !ISuscomTRACTOR ADDRESS <br /> LICENSE C 57 C-61 0-09 Other ER 1 ALO i(J LJ EAT p1 DATE_j <br /> GCOGRAPtOCAL INFORMATION: CQOrdirtatCa X y_ Township__ Range S&cd*n_ <br /> INTENDED use Domesti0y.vate IrtigatiioflAgnCuRurai Industrial Water Quality Monitoring Soil SamplinglCharactori-d- <br /> Public WaterSystemCOKW Nam or Mirm u <br /> it EMterer+t htrn iJweer � . <br /> Dow <br /> TYPE OF WORK New Wad Replacement Well Wetf ANetatioNModitttation aortwn vdttai,ga , <br /> Monitoring Well(s) S of wails Soil Sering(s) Geotechnical <br /> Out-Ot-Serviuee)Oldl Out-Of-Service Wail Renewal Cross-Connection Repair <br /> New Pum V P-0 R eni R 'r Raise Well Cosi / <br /> WML CONSTRUCTICN " <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Outer X• <br /> Proposed WON OtM ft Excavation in diameter open Bottom Gravel FecIdGraval Size in diameter <br /> Conductor Casing in diameter 1 Conductor Casing Depth R +. <br /> Steel 'Plastic Staintest Steel Other <br /> Wet!Casing Diameter_ in ThicknesslGauge/ASTM SChed sack m xJ7 water ice' <br /> Grout Seal Depth It Neat Cement(94 lb begy5-TO gal water) Sand Cemant <br /> Bentonite(2C%solids) Otiear <br /> Grout Placement Method Pumped Froe Fag Other Retardant I Accelerator(name) <br /> PeDESTAL trtslaited By Driller, .Pump Contractor Other R Thick in Crinsty Sox Saove Pipe <br /> ncrete Pedestal Dimensions:Width_h Length <br /> !Eu-- Submersible Turbine Other HP <br /> Pump S It Send Water Levi tt <br /> i HERESY CERTIFY THAT I E IS <br /> HAVE PREPARED THIS APPLICATION AND THAT THE Wit WILL BE DONE IN ACCORDANCE UWH SANANCESR <br /> CURRRREENT`ANDAACTITY VEaWITH TH£STCALIFORNIIA CONTRACTORS STSTATE LAWS,AND RULES AND A£TE LICENSE BOARD LA AND ! AMT uv COMPLIANCE WRNMY REQUIRED S ALL � <br /> WORKERS COMPENSATION LAWS. � 7 <br /> MINIMUM 24 UR ADV A CE NOTICE REQUIRED POR4N$t C _PLEASE CALL(209)9 <br /> SIGN'D .-� Tm.E r DATE <br /> ' I � <br /> l (XIVED <br /> EP 2 3 2016 <br /> i <br /> CNUB-AL HEALTH <br /> 1 I t, ITlSERViCES <br /> II II i <br /> SEC <br /> fP RTMENT SE Nj. lJ <br /> Y � td '7� <br /> CC Cly I <br /> yr1}OoaytEy AL plication Accepted By Date Area Employee 1011 <br /> ;ppA ttE Grout InspeCtiOn By Oats =- PEC AL 1fl/BII P6PtNit <br /> HEP= , IVER to 7 W WAReceived <br /> Pump inspe ion <br /> Soil 6onttg l n By <br /> Date Catstruucted Well Depth tt <br /> COMMENTS G7 <br /> 1 Pf SC Received Checldl Amount PerTtdU Invoice ii Web iD1t j <br /> I Codes Into I S i Rtmkted <br /> 192 <br /> i - - <br /> ' WELL IFLW P'EMT <br /> .130!2 <br />