Laserfiche WebLink
WELL/P�UWPERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-hfEFUNDASLE PERMIT I:ALL (-LU`d) y5J-/by/ FOR INSPECTIONS hAPIHhb 1 YEAR FROM DATE ISSUED <br />ADDRESS 1434E. WOODBRIDGE RD. E. CITY/ZIP WOODBRIDGE/95258 <br />SS STREET GOLF CT. APN NEXT T0013-110-01 PARCEL SIZE LA DEUSE APPLICATION # <br />IER NAME PG&E PHONE 209-932-6461 <br />IER ADDRESS 4040 West Ln CITY/STATE/ZIP Stockton / CA / 95204 <br />CONTRACTOR PG&E PHONE <br />CONTRACTOR ADDRESS 535 S Center St CITY/STATE/ZIP Stockton <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE ■ C-57 C-61 D-09 Other <br />CITY/STATE/ZIP <br />NUMBER 339629 <br />PHONE <br />CA / 95203 <br />EXPIRATION DATE <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE Domestic/Private I Irrigation/Agricultural I Industrial I Water Quality Monitoring i Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK ■ New Well Replacement Well Well Alteration/Modification ■ Other Anode Well <br />#of borings j, rings <br />Monitoring Wells) # of wells Soil Boring(s) 7 Geotechnical � ` <br />Out -Of -Service Well Out -Of -Service Well Renewal . 4- I Cross -Connection Repair <br />New Pump Pump Replacement Pump Repair I Raise Well Casing <br />WELL CONSTRUCTION 5E1" <br />0.8 <br />Drilling (Method : Mud Rotary Air Rotary I Auger Cable Tool Push Point I Other ?016 <br />Proposed Well Depth 200 ft Excavation 8" in diameter Open Bottom i.I Gravel Pack/Gravel Si �w nQV�MIC ' r <br />Conductor Casing in diameter / Conductor Casing Depth ft AtrH"„OvE%'MA TM . <br />Well Casing Diameter 2 in Thickness/Gauge/ASTM Sched I Steel ■ Plastic I Stainless Steel Other NT <br />Grout Seal Depth 25' ft Neat Cement (94 Ib bag/5-10 gal water) ■ Sand Cement 10.3 sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method ■ Pumped : J Free Fall Other I Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor i Other <br />Concrete Pedestal IDimensions: Width ft Length ft Thick in I Christy Box . I Stove Pipe <br />PUMP Submersible Turbine ■ Other __VL_ HP Pump Set ft Standing Water Level ft <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 IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MIN HHO/UIR VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED V , TITLE Associate Distribution Engineer DATE 6 T-7// <br />PERMIT EXPIR r1V <br />P�i►ma�►�ave e�p+�d <br />,pnptkge�toompleted or Inspected <br />by Ernqmtmertal Hearth Divisbl <br />`CIA U <br />WOODBRIDGE RD. E. <br />GAS MAIN <br />81' <br />8" ANODE WELL <br />•_5 <br />N <br />02 <br />#1434 <br />DEPARTMENT USE ONLY <br />Application Accepted By '�Z� Date <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil Boring Inspection By L Date <br />COMMENTS C n OAA 07 /;L1�'tt��n :1 /IQ/?�w. ' � 5•��� <br />Area Employee ID# Cp <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />Construct@d Well Depth <br />ft <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Well ID# <br />I <br />l� <br />(L <br />R n <br />cW075730 <br />EHD 6 WELL /PUMP PERMIT <br />4/30/12 �:4072-74-1f <br />