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WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> rn <br /> JOB ADDRESS 1651 N Beecher Rd Wel1#1 CITYIzIP Stockton,95215 <br /> D <br /> CROSS STREET S.of Hwy 26 APN 103-020-09 PARCEL SIZE}O LAND USE APPLICATION# <br /> OWNER NAME <br /> PHONE 607-1078 <br /> C12-310 <br /> OWNER ADDRESS CITY/STATE/ZIP Stockton.CA 95212 <br /> CONTRACTOR Hennings Bros. Drilling Co., Inc. PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd CITYISTATE/ZIP Modesto, CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 290813 EXPIRATION DATE 05-31-2018 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Mn3 NY Section_ <br /> INTENDED USE Domestic/Private x Irrigation/AgdUcuftural Industti O g II m <br /> Public Water System <br /> If different from Owner: Water ys em ame on e oton.tRF r <br /> TYPE OF WORK x New Well Replacement Well L Well Alteration T ,. <br /> Monitoring Well(s) #of wells D Soil Boring(s � , °f ° r: I'�G ote nical °� <br /> Out-Of-Service Well C Out-Of-ServidiliU Redming� r nspectcld <br /> New Pump Pump Replacement I I Pump Repair R ise W II <br /> WELL CONSTRUCTION I I ivision <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool i Push Point x Other Reverse Rotary <br /> Proposed Well Depth 500 ft Excavation 26 in diameter I Open Bottom x Gravel Pack/Gravel Size 6/8 blend in diameter <br /> �.x Conductor Casing 3n in diameter / Conductor Casing Depth 50 fl <br /> Well Casing Diameter 16 in Thickness/Gauge/ASTM Sched 1/4" x Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 50 ft Neat Cement(94/b bag/5-10 gal water) x Sand Cement 10.3 Sack sack mix/7 gal water <br /> Bentonite(20%solids) Other 30"x 50'Conductor cemented in <br /> Grout Placement Method x Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller x Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width It Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level It <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 /> .a')n pCNIR Ar)uAxa{rF f- TillF f vniiiRFl)vnR.it.;!;PFCTIONS I <br /> SIGNED 9V TLE r . Vol G DATE -/ Y <br /> 0 G IL <br /> AEC <br /> SA ENV <br /> HEALTH <br /> D€ ARTMENT USE qNLY ��j ``// <br /> Application Accepted Date Area_t �T— Employee ID#1^ o <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date onst cted W I th ft <br /> COMM'E-NT,S' <br /> PE SC Received Chec Amount Date PermV Invoice# Well ID# <br /> Codes Info B s Remitted Service R uest# <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 8/04/08 <br />