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WELUPUMP PERMIT <br /> SAN JOAQL,t@i CioUNtY ENvstoaaEwAL HF.ALTN DEPAKmEM 198E EAST HAMTON AVENUE•STOCKToN CA 96206•(209)4883420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADomss 4 S Acl s 1' e- Dr. Crryalr A c.:.r�,S�t1 CA U <br /> CROSS sTRm T46 "OpPIi 06 —3C-C- 15 PARCEL SIZE LAND USE <br /> ^A'JPPUCA"W IR/'� y�Qy�j <br /> OWNER NAME '1 o T t s P..':20 9 x900`. c)�� p <br /> OWNER ADDRESS CI ` c' p CITYiSTArETGP �iT Li C.��'} �j <br /> CowrRAcToR V C�1�'� f` �✓�'�\„ 1 /PIIOI�\ d(A J <br /> CONTRACTOR ADDRESS P x�•X r�{ GTYISTATI�► l�`dl.. c 1✓4� <br /> SUWA "U'arot PROW <br /> SUacowmcroa Aom" CITWSTAN421P <br /> UCENSE C-57 i C-61 C D-09 „Olh Numm EXRRA"Ok DAn L <br /> DomFsnc WELL SAMruke:C?General WnarmlltCo iform Bacteria(4391)[:'.Dim(4392)C Anemic(4393) <br /> WmNDEO USE sEc+Privele 0 trrigatlot/AWicultural C industrial C Water Ouadty Monitoring r:liar motion <br /> r Public Water System <br /> K d"We`4 Com Dear Water 6yaLm Near Corset Nana a Www Nt,ee.r <br /> TWE Of WORK New Wed U Replacement Well C Wall,NtwvIloJMaMcatbn Dow <br /> MormtorbN Webs) E of weds Sri Borb*s) e a emnw Geotedw4cal s d WWW <br /> Ou-Ol-Service Wall C Oul I-Sarriu Wed Renewal 5 Cross-Connecdm Repair <br /> Naw C Pwnp Replamnant r Puny Repair C Raise Wei Coming <br /> WE"CONSTRUCTION <br /> Drying M*thod,)�'Mud Rotary r C Air Rotary G Auger Cahie Tool r Push Point !, Otlner <br /> Proposed Wall Depth 775 R Ettavadon 3 in diarrnetet i_Open Bottom Gravei Pa&?Gravel Size V4— fn damater <br /> :::Caxluuor Casing in diameter i Conductor�Caaft Depth R <br /> W <br /> W Ca" Diameter In Th&ne&r-- C <br /> auge/ASTM Silted C C '*;Steel Plastic t.;StaWM Steel ::i Other <br /> �R Ssal Depth 1G R Nast Cernent(94 Jb 6agl-10 gal*anon) pad Cement 1 C sack mi,d7 gin water <br /> [:BentarYta(20%solids) o Other <br /> Grout PtacwasM Method C Free Fad ❑Otter Retardant!Accelerator(tion») <br /> JE"" ped By Drdkr I i Pnsrp Corwac Otter <br /> Conerw Pedastrl earesnsioans:Width �ft Length A Thick in D Christy Bos r,stow Ph" <br /> law StsWngralble.Turbine C:01._--P== Pump Set ft S Water Leval R <br /> I HIS HEREBY CERTIFY THAT 1 HAVE PREPARED TAPPLICATION AND THAT THE WORK MLL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> M,011MUM 48 HOUR ADVANCE N019CE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)(995553-7697 <br /> TMA 0 t DATE 7 <br /> i. <br /> t, <br /> 3 <br /> i <br /> i <br /> DEPARTMENT USE ONLY <br /> Appikation Accepted By Data Ares Emp"ID* <br /> Grout Inspection By Date (7 SPECIAL WON Perrnk <br /> Puarp InspecYton By Date ❑ WAIVER Received <br /> Sod Boring inspersion By Dade Constructed Wall Depth ft <br /> COMMENTS <br /> PE SC Codas info Received CBy C cio Remitted Anmmt Date P Sarviunnit/R*qua invoke III Wall IDI <br /> EMD 4a-06 roncea fll Mia WELL PUMP PERMR <br />