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P) <br />RV <br />— ILLI "N_AW:6 _LIOZ_'lZ'aaa awil paAiaaa� <br />WELL/PUMP PERMIT r <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - 1209146a-342( <br />1NtJIV-r(EFUNDABLE PERM <br />CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JoeADD.s <br />20808 omstock Rd <br />cons, Linden, CA <br />95236 <br />CRoss STREET <br />D e M a r t ill L n <br />A.PN� 17i� I <br />PARCEL SIZE��' LAND USE APPLICATION u <br />,OVINES NAME <br />D a n la) D a m rut <br />y n �` T e j a n o <br />PHONE <br />OVINER A00REss <br />P O B o x 655 <br />CITY/STAIE/ZJP Linden , CA <br />95236 <br />CONTRACTOR <br />Purviance <br />Drillers, Inc <br />PHONE 209-887-3554 <br />CONTRACTOR ADaRFss P 0 3 o x 64 <br />CITYISTATEIZJP L i nde n , C a <br />95236 <br />SUBWA-rRACTDR <br />PHONE <br />i <br />ADDRESS <br />La:ENSt LXC-57 ❑ G61 D D-09 D Other <br />CrTYISTATEZP <br />Nu... _377923 <br />E tPIRAIION <br />7/31/19 <br />(,om—Tic weLL AAmpuNG: ❑ General Mineral/Coliform Bacteria (4391) L 0ibromochloropropane (4392) :) Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private Ni Irrigation/Agricultural D Industrial C Water Quality Monitoring 0 Soil SamplinglCharaclerizalion <br />❑ Public Water 5y3tem <br />If Ciaereatrrom Ovmar. Water sptem Name CoNact Name orPPone Number <br />TYPE OF WORK M Nevi Well C Replacement Well ❑ Well AlteratioNModificatfon O Other <br />D Monitoring Well(s) of wells ❑ Soil Boring(s) 9 o bon"V C Gectechnical o°r Donnys <br />U Out -Of -Service Well D Out -OP -Service Well Renewal D Cross -Connection Repair s i <br />11 New Pump C Pump Replacement ❑ Pump Repak D Raise Well Casing <br />w <br />'Drilling Method R Med Rotary G Aa Rotary D Auger O Coble Tool n Push Point O Other <br />r <br />Proposed Welt Depth .7e;1L7 ft Exnvation !9-/2 it diameter • Open Bottom Q Gravel PatlJGrawl Size in diameter <br />U Gonducfarr C>asing in diameter / Conductor Casing Depth ft <br />Weft Casing Diameleri Thlydtt/1f�lSSil .,,ge/ASTM Sched _ ?� 1! Steel ❑ Plastic ❑ Stainless Steel U Other <br />Grout Sea[ Oepth y - ft {"7 Neat Cement (94 /b begr1_10 gar water) a Sand Cement JO. 3 sack rrix/7 gal water <br />❑ Bentonite (20% scGds) 7 Other <br />Grout Placement Method WPumped Free Fall D Other 0 Retardant l Accelerator <br />PEDESTAL Installed By WDrIler 0 Pump Contractor ❑Other <br />U Concrete Pedestal ODimansions' Width $ l ength h Thick in ❑ Christy Box D Stovepipe <br />PUMP D SubmersibleD Turbine D Other HP Pump Set ft Standing Waler Leve: R <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL 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 W COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAW _ <br />INUYI 24 H D NCE NOTICE REQUIRED Fqc�R INSPECTIONS -PLEASE CALL (209) 953-7697 <br />SIGNED Tm-eCorpor Sectary DATE12/21/17 <br />® <br />Application Accepted By � � Date � � !� ( Area 0hq Employee IDii'�/�'�"_/ <br />Grout Inspection By Date r' ❑ SPECIAL Well Permit <br />Pump Inspection By Date ❑ WAIVER Received <br />Sal Boring Inspection By Date Constructed Well Depth <br />COMMENTS <br />Eno C3 -0E aRtn6 <br />9•d <br />VZSCZ2960Z <br />(�� 0G8 ?4-D <br />WELL &UPIN PERMIT <br />w <br />LTH <br />out s.lajjuQ aoueimnd IRN:O � L 16Z oaa <br />-.l <br />iZ](rte/■/�����•�' <br />�'7+Y��fl�'��//� '07917F <br />- <br />Eno C3 -0E aRtn6 <br />9•d <br />VZSCZ2960Z <br />(�� 0G8 ?4-D <br />WELL &UPIN PERMIT <br />w <br />LTH <br />out s.lajjuQ aoueimnd IRN:O � L 16Z oaa <br />