Laserfiche WebLink
' WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY IPUI3LIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISI t. • E <br /> <br />104 E. WEBER AVE. THIRD FLOOR STOCKTON CA 95202 (209) 465-3420 <br />AON.-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 4 <br />10B ADDRESS 3ooqs-. prom LAI? E- APN <br />CITY/ZIP 51-000-137) PARCEL SIZE 2_3 <br />OWNER NAmEr5(15,5P iC 5 ADDRESS4Ss r0110f5__q_ <br />CTTY/ZIP Co ty hi WO, new lioa# PHONE y/ e -53/-ff 9-0 5" <br />coNTRAcToR_uo /to (44ter Di frifid3 ADDFTESS 30 5. iiiire:9 Ed • <br />CITY/7JP <br /> <br />14r/ OCIC (7 ,5-• 8 0 PHONE (067 '7- 7ci,r2 C-57 IICENSEA fiNahrEXP DATE 03 <br />GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE SECTION <br />TYPE OF WELL: 0 NEW WELL 0 REPLACEMENT WELL 0 MONITORING WELLS 0 OTHER <br />INSTALLATION; LI WELL SYSTEM REPAIR LI CROSS-CONNECT REPAIR 0 VAPOR EXTRACTION WELL 4 <br />TYPE OF PUMP: CI NEW 11 REPAIR IL?. DEPTH PUMP SET FT. FIRST WATER LEVEL <br />CI OUT-OF-SERVICE WELL CI GEOTECHNIC.AL fl El SOIL BORING Xi/ESTRUCTION: (P ‘474 IalSikftik, <br />641/ A5 Pt t-Y erfiCed /NTENDED INg DISEE_QEMIAL LOMMLIMUTYMMATUM - <br />0 INDUSTRIAL CI OPEN BOTTOM WELL EXCAVATION VIA_____ CONDUCTOR CASING DR_____ <br />0 DOMESTIC PRIVATE 1:3 GRAVEL PACK/SIZE WELL. CASINO TYPE WELL CASING DR <br />D PUBLIC/MUNICIPAL n DRIVEN GROUT SEAL DEPTH SPECIFICATION <br />ET IRRIGATION/AG OTHER GROUT BRAND NAME <br />CI MONITORING GROUT SEAL PUMPED: CI YES 0 NO <br />0 CHRISTY BOX 0 STOVE PIPE CONCRLTE PEDESTAL BY DRILLER: 0 YES CI NO <br />APPROXIMATE WELL DEPTH <br />PROPOSED CONSTRUCTION/DRILLINO MEMiOD: MUD ROTARY AIR ROTARY AUGER CABLE OTHER <br />I HEREBY CERTEFY TIIAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORE WILL BE DONE IN ACCORDANCE WTTEI SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY C,57 LICENSE IS CURRENT <br />AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br />COMPMSATION LAWS. <br />MINIMUM 24 HOUR ADVA NCE NOTICE REQUIRED FOR INSPECTIONS <br />° -4-- TITLE SeLarreds DATE 5-0/--e/ ...•....m....... .. .......... ............mm. mil .......... ............m.= memi mommmimmmmm mmilmmmummmminm .0mumm0 mommmmmmm MIIIIMINIMIIIIMIUMM1111201M AillIIIMINIMI 1111111111111111111111111 MMIIMIIIIIIIIIMIMMMINIEWIMAItAllillillitallailINI MMMINNIM11•111 . MIMMMIMMMMEOMM: MEMMMMM MMMIIIMMMMMMIll <br />MMIIMEMM=EMMM. MIIIIMMMU'MMIWOMMMIll <br />MMMOWIIIMMM MMIIIIM MMMMMINIM MIIIIMMim Mm MI rmmmilymm mmmmmII Imwm mmirpowmmmel <br />1Folk •g 12154114111. ..... ..• ( .... ..m. ... ...to ..... ....I... .... .= ...Jommm...m.Rm.m.. monft.......m.. ...... ....msaw .... mm .. tm..........a mm ......mamm...m.. .. . .... .1. . .. ... .......m.m.mmi.... ....vim • 1...mm.... ............,m..... . ..okiof mot - ft.-1mm vIrm.mmimm.m. immimm........= Imiimmmol— wilm—mw mmmmmm =Amp mown mmmmmmmmmmmmmm mmmmmm m...-Eit „ 11 mm11= mmmmmmmmmmmmmmmmmmmmmm mmmmmwmmmmmmmmmmmmmmmm <br />immmmmmimmm=mmmommmmmmm m , ININ mmmmm mmmmm mommmm mmmmmmmmmmmmmmmmmmmmmmm <br />Application Accepted By <br />. <br />. di / <br />DEPARTMENT USE ONLY <br />Daze ri fr2/0 I Area Y)-- 11 EMPIC43 <br />Grout Inspection By , -, Date Pwrqi laspectcd By Due <br />Destruction Insiicctum(gr. . _.,.. — —...., . rOt?' 9'-' 4. e. D ate <br />COMMENTS: 2 wok s -1,-, , Jeri req1 - ,o—ni nil,- n s--( lervi c ce /7,/, t1-04 <br />..-ir 77 iq 3 --.4%.-/ ..4./C:i3 - r <br />,e,........ • A•ez,, '',1*-5-- GTO --........i.r..-,e,,,-.,e2-3„,.. c-49,54 -f---14. ---•"-- ..4?..g Al .42 . 4rd c-ArrwrAfra--,._ PE SC AMOUNT IIIW RECEIVED D ° PERMIT/SERVICE REQUESTS INVOICES WELL IDIt CODES INFO REMITTED I -- .% BY <br />'f3 73 /69 1 KO'''' -./41,, 3 Mill tA g4-4o) 21 i 7 17.)--r-ta <br />11373 /(0( 1,0"- \ _ :3 t.-7.,41.,- <br />(„5-R00/i---7---R07(s..8- <br />0