Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .2�� � tJt/All's LP <br /> PARCEL SIZE/APN CITY/ZIP_ 5 �, <br /> U l�+� Cwt9unJ n <br /> OWNER NAla ` ey —ADDRESS:Pl� CX jU l AI VJ�!l2�77 <br /> lop <br /> CITY/ZIP <br /> SC' ,,,1_.,��\\���27 C'Z-dj PHONE <br /> �/A p <br /> CONTRACTORd & l(J� ADDRESC, <br /> CITY/ZIP_-�i ,,ol� PHONE <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br /> TYPE OF WELL: ❑ NEW WELL ❑ REPLACEMENT WELL ❑ MONITORING WELL# XQTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW ❑REPAIR H.P. DEPTH PUMP SET FT. FIRST WATER LEVEL A <br /> ❑OUT-OF-SERVICE WELL GEOTECHNICAL# <br /> OIL BORING—��� %- DESTRUCTION:e ��cr�'�A <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL ❑OPEN BOTTOM WELL EXCAVATION DIA CONDUCTOR CASING DIA <br /> ❑DOMESTIC PRIVATE ❑GRAVEL PACK/SIZE WELL CASING TYPE WELL CASING DIA <br /> ❑PUBLIC/MUNICIPAL ❑DRIVEN GROUT SEAL DEM SPECIFICATION <br /> ,� <br /> ❑IRRIGATION/AG OTHER GROUT BRAND NAME ,�j�2e;�l�J��N_�// <br /> ❑MONITORING 24 HR NOTICE GROUT SEAL PUIyI1P,FD:+ ❑YES ❑NO <br /> ED <br /> ❑CHRISTY BOX ❑STOVE PIPE FO ALL CONCRETE PEDESTAL BYq?tIf: ❑YES ❑NO <br /> APPROXIMATE WELL DEPTH I N C--:I—I(N'S & _ _/�4e_ <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: <br /> TITLE: G / DATE: <br /> I , <br /> Wne Txw-^ II <br /> 1 <br /> � ruirwa STATtD11. 1 <br /> .•I I t-IW,SEE IRRICAtION KE I- �. _•.�.. `: I, . <br /> P'lw. SPIT L-J I I <br /> lOROUNDwATER WELL �, 1 <br /> J'Cw SUPPLY TOC <br /> I NAINTILMANCE IIL.DC T ORM <br /> C1Y '. I 11 P '24'0 DIS IPIBV< t <br /> 2 12' TANK DRAIN.'. '1q' 11 11 11 II BOx SEE 1 <br /> TO NN R .•�'♦,. 11 11 11 11 I <br /> FDC I U' 11 ti II II <br /> SlIT U-10/ 5 FTT <br /> 7R - FOC B'A Oft" <br /> 1 11 11 11 Il 1 <br /> i CWT- D.A.-- . n u�a II 2'-D' VADF .IOO' I <br /> 1 t II 11 Ill 11 L6 SEPTIC TREN E31 <br /> I <br /> MAINTENANCE u I II , AT 12-CC tTYP)BUILDING ' �V µ SEE NOTE <br /> AND <br /> 1- 1•I/�'ti II 11 II <br /> p nl <br /> ' - PROVIDEAS D BY 1• I�! ' I <br /> IuTUT'CO I, <br /> 1.• I p I II <br /> TB� q u n I <br /> I <br /> "nem AREA i'OR <br /> IOOR LtAON Few <br /> T- Y•I:w �. .J <br /> -T-r_ --a--- <br /> MPARTMENT USE ONLY <br /> Application Accepted By Date -- Area <br /> Grout Inspection By Daae Pump Inspected By -Date <br /> � <br /> Destruction Inspection By Date-7- -LU <br /> VJ <br /> 1 1 <br /> COMMENTS: <br /> PE SC AMOUNT CHECK#/ RECEIVED DATE PERMIT/SERVICE REQUEST# WELL ID# <br /> CODES NFO REMITTED CASH BY <br />