Laserfiche WebLink
WELL 1 PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE 34"FL-STOCKTON CA 95202 - (209)458-3420 , <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED64 � <br /> (9CITYIZI P''t �� �i9� �ip!/�GJ J ate "' J� <br /> JOB ADDRESS II �y/ J`� ��7/^/ <br /> CROSS STREET A� A P N 0��3/,31/ •v _PARCEL.SIZ r .i LAND USE APPLICATION# 7 � <br /> r PHONE 0 — <br /> L <br /> W <br /> OWNER NAME Qom^/ ��J /per /2']/y, I,Q !/ <br /> OWNER ADDRESS 1]ST' 1 '`� ` ' "'0�" 4UC (� .y-y _ CITY/STATE/ZIP L/1�r_`^'�/�//c/)_ C4 1 �j •+� J� <br /> 1 /,f 1 l!i l'+-- 1 �4 PHONE <br /> CONTRACTOR <br /> k CONTRACTOR ADDRESS"�� (w�tr/4t/,F- ) ,CITY/STATE/ZIP <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS C[TYISTATEIZIP <br /> f II <br /> I LICENSE <br /> 4-57 ❑C-61 dl 13D-09 ❑Other NUMBER v/+ V EXPIRATION DATE <br /> '! y Township Range Section <br /> GEOGRAPHICAL INFORMATION: Coordinates X _ <br /> I �,,! 1 Sanip'i h ractcrization <br /> I INTENDED USE omesticlPrivate ❑Irrigation/Agricultural ❑Industrial Wa ei _�iNlo`tori f' <br /> ❑Public Water System - <br /> ontacame or oneum Number <br /> If different from Owner: ater ystem ame - <br /> TYPE OF WORK ew Well ❑Replacement Well ❑Well AlterationlModificatiort''2i 14TO AVIJIW 't <br /> k ❑Monitoring of wells ❑Soil Boring(S) oIVung complgt earnijAs ectedofborin65 <br /> ❑Well Destruction' ❑Out-Of--Service Well ricettibyeNew Pum ❑Pum Replacement ❑Pum Repair l 1 <br /> Dig ��on <br /> air <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary Air Rotary ❑Auger ❑Cable Tool ❑Push Point ❑Other <br /> I Proposed Well Depth B Excavation,- in diameter ❑Open Bottom Gravel Pack/Gravel Size !�n diameter <br /> ❑Conductor Casing in diameter I Conductor Casing Depth <br /> Well Casing Diameter _G in' Thickness/Gauge/ASTM Sched 131 Q _ ❑Steel Plastic ❑Stainless Steel ❑Other <br /> Grout Seal Depth /00 ft *eat Cement(94 lb hag 15-10 gal water) ❑Sand Cement .rack mix/7 gal water <br /> E ❑Bentonite(20%solids) ❑Manufacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted <br /> Grout Placement Method AT9mped ❑Free Fall ❑Other ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller ❑Pump Contractor t' Other &W AVL <br /> Concrete Pedestal Dimensions: Width ft Length T ft Thick in ❑Christy Box ❑StovvePiip�pe <br /> PUMP Submersible ❑Turbine C3Other HP— _ Pump Set (A6 ft Standing Water Level 4J( ft <br /> R IF HA PREP D 1 TION T E WO E DO E 1 CORDANCE WITH SAN ` <br /> J U COUNTY RDI C TAT W A AND 10 I SO T T 1R 5 <br /> C ND AC V CA NI CON CTORS 5 TE LICENS D DTH 1 M COM IA E WITHr <br /> K LA <br /> N 4 D NCE NO CE REQ E 'O INSPEC' OT% i <br /> SIGNED TITLE DATE A <br /> �J�/�J <br /> X91.6 NAIL Z: �30 Q V CJ <br /> _" o0 <br /> CHSR <br /> 3570 i 3573 <br /> BRIOGE SPIKE W 60d NA - <br /> ri !� O1� 87tN. 053 <br /> " 3947 <br /> 4 A50a� tvik <br /> _ <br /> o <br /> �Q I S N O Q IN O N <br /> v� C� E Vi OME mi ITT <br /> PAIfffilEffr <br /> FENCELINE SURVEY <br /> >, IPU 2(03-2.30- 0r <br /> t"-200' FOR VICTOR .BULL <br /> of=PROPERTY DESCRIDED AS TRE 4EST SAIF. OF 7'HE <br /> BAST HALF.of THE NORTHEAST QUARTER OF SECTIONS 8 <br /> .. TOWN2KEP 5&OUTS, RANGE 4 EAn.xi D.li. <br /> t i - IN-T3NWCORPer TSD AREA -SAN MAQUIN COUNTY <br /> + n. .. RNL+<- / <br /> L - B-.�„ „6� _` ,sc STATS OFC6I"O <br /> Appiication Accepted By Date .O Area Employee ID# <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Destruction Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SCReceived Check# Amount Date Permit! Invoice# Well HO <br /> Codes info B ash Remitted Service Request# <br /> �1 n3 z S fl 5+ 3 C ' <br /> Qav '�) 7 <br /> WELL PUMP PERMIT <br /> EHD 43-02-006 _ ,w <br /> 816/04 <br />