Laserfiche WebLink
r7 <br /> I .. ley A TPARCEL Slzz'�' <br /> " ND USE APPLICATION I U <br /> — C <br /> Mt V <br /> �6 <br /> R'ADDRM'L' <br /> • trrRA ':...... PHONE ...... <br /> V it <br /> WOCONTRACTOR ADDRE <br /> SS CITY/STATEIZIP <br /> ;)M;#fjji4;N. 0 <br /> YC.57, 0 C-6 1- n 13 D-09 0 Other NuNiHE R ExPIRATION DATE <br /> h00ATI0Nf, 'P0*rd1naIeS X "1f <br /> Townablp--, Rang*2 <br /> INTENDED USZ,'— Soil Simplifi"fTD0Mc&1iC/PAvafif 13 Irrigation/Agricultunal 0 Industrial '0 WatirQiialii-Mon-itoring.."_'"0 glCharacterintion' <br /> PublieWriter Seim <br /> WK L'. (diffis.rit(W. Water�ystcm Nam Niun,,or��O.ncr. <br /> tlk+ <br /> YikfiTVPZ OF WolftstilkD New WeVg'A7)00 Replacement Well JfL 0 Well Alteration/Modification <br /> , W13 Test Hole 014 !�rl Other., <br /> )lkk 's}OtMonitoring 'r147, 0 OcotecVhinical <br /> (3 16 <br /> Well Destruction`— 0 Out-O 1130utwOr-ScrviccWelll n <br /> C1 Cross-Connection Ran�j. 0 Nc�;PumpT'.1 11 0 Pump Replacement, 13 Pump Rp,�,rcc�14P <br /> WELL C0NsFrRucjrqN: <br /> Drilling Method AS-Mud Rotary 0AirRotary 13 Auger 0 Cable Tool 0 Push Point '00ther' <br /> sp �q ion in diameter 0 Open Bottom iZe <br /> Proposed Will. Depth J it Excavation 0-Gravelpaci/6ni,cis in diameter <br /> Conductarr�asmg in diameter. Conductorcasin Depth it <br /> i in -Thickness/Couge/ASTM Sched. Steel btwtic 0 Stain <br /> less n1cis Steel i. 'D Other <br /> ,W <br /> th 0 Neat Cement(94 lb hag/5-10 gal '-;113 Send Cement <br /> Park mix 1 gal water <br /> ent, I El Manufacturer Spec%solids % Name" <br /> . <br /> D Specs on File 13 Specs Submitted entonitc(200/oxolids).- Retardant I Accelerator(name) Is, r <br /> .Pumped 13 Free Fall 0 Other <br /> Placement <br /> V&d­ 'Pit 13 <br /> ,I, PEDLWAL' Installed By 13 Driller _67pump Contractor 0 Other <br /> D Concrete Pedestal Dimensions: Width_ ft Length RThick in 13Christyllio 0 Stove,Pipe <br /> P�mp OS ubmemilije 0 Turbine 0 Other HP Pump,Scf"�t � R Standing Waler Level <br /> I, PUMP <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK Will BE DOINfi'IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY,THAT MY REQUIRED LICENSE IS <br /> ICURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> e 'WORKERS ,OMPENSA <br /> T <br /> N ION LAWS- . ....... <br /> = <br /> OUR ADVANCE NOTI�E�R�qU I EDTOR-MINIMU 24H rl <br /> SIGNEB' TiTLE'* <br /> tw <br /> I r/ Vt, t7, I Z)V�v IA1 <br /> 7 7_177IZZ7" O J I <br /> AL <br /> DE PA R T M E ��O N(�Y <br /> Application Accepted By r Date Area Employee ID#...... n- Date13 SPECIAL Well Permit <br />