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f i <br /> WELLIPUMP PERMIT <br /> Scat JO.A2VIN COUNTY ENMRGNMEN7AL HEALTH'DEPT 1865 East Hazelton Avenue-97OCKTON CA S5205-e232 -(20914 69-3420 <br /> trlOH-REFUNDABLE PERmrr CALL <br /> W (2'9)9 537697 FOR INSPECTIONS - EXP{iRES f YEAR FROM DATE ISSUED D <br /> JasAoDnEt: MO Y1 u) c,,Iz,P-Tsjil cy(/ ) _ <br /> GROBB STREET APN 74+58A:�0(- tqf} <br /> PARCEL 8812E I-Atic U APPUCATlU-1**iryf <br /> OWICER NAME yrl� �/L "//� (}-�� _ -_ PHffsl1E 7��• "� L�D "' - <br /> Ow"ER ADURESS ��/�� V' 4■V V �(..�/ CITWSTA T EJ'ZIP <br /> i k.MMTRAG-TOR N & S IRRIGATION INC. 209.599.3456 <br /> CcNrRACTOPAzmRrsa 215 W. MAIN STREET RIPON, CA. 95366 <br /> SuBcortTn'ACToR PHONE <br /> SURCUNTRAcTcR ADDRESa CrryfSTaTEaZIP <br /> LIDEH@E c C-57• C-nt [)-Do X 0&,S- C10 NUMBER 662732 ExFn.T•1'ilN D.7. 01/31/15 <br /> GEDCRA"FC! kF01RM Icn: Coordinates X Township Range Section <br /> INaEato9€ aEYD&nesadFrvxe Irnga:mningriv.&Turat r Indust al Water lily Vlan4omg ^3c Samgling9G ac et 3 ia^ <br /> Public A:atar System <br /> llzr!r Ls:Iron ClW,C. — Yom-- x_._ -.at5:au-a(f .. .[i- 1Y.°.•— <br /> Typr Or WORK - N-w Well lacement alell C'Well rSteratPon'fvlCd:�Cat�r- .. Other <br /> eanng+s, Ea'ecieical r"' -.. . ._ .--.. .._�• _ - <br /> out-t:f-S. ell r 0,1,Of-SCry s W;g Rsnerwa :^.res-=_.onnecttt�n epalr <br /> New Purr ump Replacement i._Pump R a�r Raise%Veil Casing <br /> WELL CoNSTRUC710M <br /> Drilling Method L, MiydRotarylair Rotary .. Auger Cable Tool . Push Pvnl, CaG� <br /> Proposed Wen Depth a. ExcavatDr, in darn,,ar G Open Bottom . Ci3awq2 Paar3ra':'el Sze in dzrmeter <br /> Csx�arADrCasing diamew f Conductor Gssa Depffi. <br /> Well Casin.g DYametw_+r Ti&kneSs;Gauge'AS:TM s iry Steel P�astic i Stainless Stea? 01her <br /> Grout Seal Oepth 't Neat CA rns nt 1194 Fb 2�aqZ-1tl ga'wa fere .. a ar:d Cement saa,rnk r gat water <br /> .. Senw ite t20°4 s;.da65' Other <br /> Ganut Placement Method Pumped < =see F SI :Yther f Retardant!ACaetera-er(name). <br /> PEQF- I&II Installed By . Dr'-ltw t-Pump CcntraCta�- =i Other <br /> {ahcmte Pedestal Diniensions.?XtRA 11 Le-;g&� ftThick in E: Christy Sox e.. Stove Pipe <br /> !Lu--M- Gr t_rst4. Turk ere Cther HP Pump Set SED f St� ing l tla er L=ve$ <br />! I HEREBY CE THAT I HAVE PREPARED THIS APPLICATION AND THAT THE'WORK WILL BE DONE PN ACCORDANCE WITH SAN <br /> JDAQJIN NTY tiliDtNANCES. STATE LAWS. AND RULES AND.REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LPCENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMP ATION LAWS.. <br /> ti9 sI Ll TO 2 H0- ,ADVAUCE'N OTIC IREDFO PE4:TIOuss <br /> StDacEc Tn ,� r DATr. <br /> czNED <br /> 420 .1 <br /> QuIN COUAryy <br /> TH bE u <br /> f <br /> r <br /> i <br /> Dp P A R T M E N T S 0NLY <br /> it Rppt€caf n f gr42y, <br /> CaFe Are., 5 � Employee 00 l�Si'rS VJo <br /> C oat Inspectale SPECIAL Well Perintt <br /> P'er nIn tior<Ey Date WArvER Received <br /> SDl born n ctc+ By ate Constructe-d Well Depth ft <br /> COMMENT' v <br /> PE SC Received C Amount Date Permitl Invoice ff WeIVID4 <br /> Codes info By RemhteA Serviea R west <br /> EMO-1 Y0, <br /> 1.1EiLJIFV F=FR%1- <br /> ssW <br />