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} <br /> . ir/r ✓�f us,�' ��. 1,, ( �ihMScan 511z��� Rh/I <br /> 18274 WELL/PUMP 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 /> y <br /> H <br /> JOB ADDRESS 754 W_ ROWMAN RD- CITYIZIPPRRNCT4 f AMP 95231 in <br /> CROSS STREET LOCKHART APN 193`-26-0TT29 PARCELSIZdD.46 LAND USE APPLICATION# m <br /> {-r <br /> OWNER NAME �L wn ``OW(r� l/M`7k��'0.- V.rlCu PHONE 209 640-21 70 •`r' <br /> OWNER ADDRESS P. :I�r�rZ CITY/STATE/ZIP <br /> CONTRACTOR Delta Pump-GTnr,KTnN ARMATURE & MOTOR WORKS 11"Gh. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 - <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE D C-57 XC-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates X- Y Township_ Range_ Section_ <br /> INTENDED USE ❑ [�Wstic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: _ Water iiystsm Name -----C-0-nTa­Cf`Na-IT-e-0-rPhona Number <br /> TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br /> ❑ Monitoring Well(s) #of wells D Soil Boring(s) #of borings ❑ Geotechnical #of borings <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump ❑ Pump Replacement Rgump Repair ❑ Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑ Mud Rotary D Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel PacWGravel Size In diameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter— in Thickness/Gauge/ASTM Sched 0 Steel ❑ Plastic ❑ Stainless Steel 0 Other <br /> Grout Seal Depth ft D Neat Cement(94 lb bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method 0 Pumped ❑ Free Fall 0 Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor 0 Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length it Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP SubmersibleO Turbine ❑ Other HP 3 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT A AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> f�1LWlltdLA 24 HOUR ADVANCE NOTICE REQUIRED FOR.INSPECTIONS <br /> SIGNED �1-�. TITLE CEO DATE <br /> 9 <br /> v <br /> W.BOWAN RD. HOUSE <br /> PUMP/WELL is <br /> located right IRE, <br /> ��behind the D <br /> garage. .o <br /> 016 <br /> IF TH <br /> F / <br /> • DEPARTMENT FUS ONLY LT"DPP4c_�en <br /> Application Accepted By LF Date l tArea h'7l 'Z/ Employee ID# <br /> Grout Inspection By Date SPECIAL Wall Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring-Inspec�Ifon By Date Constructed Well Depth It <br /> COMMENTS -i Le, Ve 7 nd�Jj Lv�fi 1-YCnfCGrICC I�G lA P LIL C S iii <br /> PE Be Received hec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B ash Remitted Service Request Al <br /> 4"i32 05� �B a 2Z �`5"' �31-16 SRc�v7H5`i5 <br /> W04/08.06 �„ e p iL�y\ r`A csW� -liA. Pwrq -A u�.y{'t^'! Il'V:L� V.�AN.tI WELL(PUMP PERMIT <br />