Laserfiche WebLink
Nw WELIJPUMP PERMIT " <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br />304 E. WEBER AVE, THIRD FLOOR STOCKTON CA 95202 (209) 468-3420 <br />NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />I <br />6 10- 0 ROB A <br />OWNER NAME P� L/ ADDRESS <br />C PHONE <br />CONTRACTOR ADDRESS 'L 4) / IV 7-," i C-7 T. Fef- 4' <br />CrffrZIP—=gefc� ,� art /1! I .PHONE C-57 LICENSE#—EXP DATE <br />GEOGRAMCAL INFORMATION: COORDINATES X— Y — TOWNSHIP— RANGE — SECTION <br />TYPE OF WELL: 13 NEW WELL 13 REPLACEMENT WELL 0 MONITORING WELL # 13 OTHER <br />INSTALLATION' 13 WELL SYSTEM REPAIR 0 CROSS -CONNECT REPAIR 13 VAPOR E� 17RACTION WELL # <br />TYPE OF PUMP- 13 NEW E3 REPAIR I'H.P—iLA—DEPTH PUMP SET FIRST WATER LEVEL <br />E3 OUT-OMERVICE WELL E3 GEOTECHNICAL C3 SOIL BORING 13 DESTRUCTION: <br />OF WELL <br />E3 INDUMML, 13 OPEN BOTTOM <br />13 DOMES77C PRIVATE 0 GRAVEL PACK/SIZE- <br />13 PUBLICIMUNICIPAL 0 DRIVEN <br />E3 IRRIGATION/AG <br />MONrI7ORIN0 <br />13 CHRISTY BOX � 0 STOVE PIPE <br />OXIDATE WELL DEPTH c7 - <br />PROPOSED CONSTRUCTlON/DRILLING METHOD: MUD ROTARY <br />C!QNSTRUCTIQN NPECIFICA119 <br />.'I' <br />WELL EXCAVATION DIA—CONDUCTOR CASING DIA <br />WELLCASING TYPE WELL CASING DIA— <br />GROUT SEAL DEPTH SPECIFICATION <br />OTHER GROUT BRAND NAME <br />RjUsill wl:fl a u elkyj I Uzi I w �w Wo <br />CONCRETE PEDESTAL BY DRILLER: 0 YES 9N0 <br />AIR ROTARY -X— AUGER — CABLE — OTHER <br />I HEREBY CERTIFY TIIAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WELL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br />ANDA WrIll THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br />COMPENSATION LAWS. <br />ININIUMI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />42' <br />;IGNED Alii ��'�DATE <br />4 —.Mz dK <br />E <br />