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v6°�l� 0' I WELL/PUMP PERMIT P / <br />SAN JOAQUIN l-OUNTY 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 ►ssuFn <br />JOB ADDRESS -"-(�3 MORSE RD. ' CITY/zIP LODI 95240 <br />CROSS STREET 9 (a FR n MTAGEAPN 0 5 9 — 2 6 — 0 2 D PARCEL SiZE1 . 6 9 LAND USE APPLICATION # <br />OWNER NAME EUGENE 'BOOTH • .`4� ( I �- PHONE 2 0 9 36 R 7 3 1 <br />OWNER ADDRESS SAME CITYISTATE/ZIP <br />CONTRACTOR Delta PUItlp CTc)(- N ARMAT1iRF g TQR WORKS $1d1ij{ , 209-466-96 _5 <br />CONTRACTOR ADDREss 646 S. California Street CITY/STATEIZiP Stockton, CA 95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE O C-57 N C-61 a D-09 0 Other <br />PHONE <br />C%TYicu'T ATFJZ\P <br />NUMBER %24778 EXPiRATIONDATE 08/ <br />GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Township Range Section <br />INTENDED USE Rj?omestic/Private 0 irrigation/Agricultural G Industrial ❑Water Quality Monitoring O Soil SamplinglCharacterization <br />0 Public Water System <br />If different from Owner: a er ys em ame <br />on a ame or one um y,,r <br />TYPE OF WORK C New Well p Replacement Well C Well Alteration/Modification 0 Other <br />0 Monitoring welts) # of wells O Soil soring(s) a of borings <br />C Out -Of -Service Well - a or borings <br />, 0 Geotechnical L Out -Of -Service Weil Renewal O Cross -Connection Repair <br />C New Pump ,Pump Replacement O Pump Repair <br />NFL I r`nn cToi r t D Raise Wall (:aainn <br />Drilling Method C Mud Rotary C Air Rotary 0 Auger D Cable Tool i] Push Point 0 Other A <br />Proposed Well Depth--- - A <br />_fj Excavation in diameter 0 Open Bottom O Gravel PacklGravel Size i <br />C Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched O Steel D Plastic'�/� , <br />O Stainless Steel O Other 5�� <br />Grout Seai Depth ft 0 Neat Cement (94 Ib bag/5.10 al wafer <br />9 ) C Sand Cement S �{l�yvate <br />6entonde (20°!° solids) O Other q� ,0 oUN <br />Grout Placement Method 0 Pumped Free Fail 0 Other 011 Ftir <br />D Retardant /Accelerator (name) F,h <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />Concrete Pedestal Dimensions: Width ft Length 9 rt Thick in 0 Christy Box 0 Stove Pipe <br />PUMP a7�ubmersible0 Turbine 0 Other <br />HP �_ Pump Sot 1 2 7 ft Standing Water Level 2,5 <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 />SIGNED <br />24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTiONS <br />�4 TITLE CEO <br />NOTE: DID NOT HAVE THE LOCATION OF THE PUMP/WELL <br />ON THE PROPERTY UNTIL THE JOB WAS COMPLETED. <br />Louise Fornos <br />nffirp Manaopr <br />DATE 9/8/2017 <br />r vac V N L Y <br />Appligtion Accepted 8y _ ? _ / <br />Date J <br />Grout Inspection By Area <br />--. q <br />Date Employee lD# ':fSCc -�t c Pump inspection By i <br />Date SPECIAL Well Permit <br />WAIVER Received <br />Soli Boring inspection By <br />COMMENTS Date Constructed Well Depth <br />ft <br />K -calved <br />Codes info By 11 <br />EHD 43.06 <br />8/04/08 <br />Remitted Date <br />qr4,- <br />Pnn37 <br />invoice # <br />WELL /PUMP PERMIT <br />m <br />J0 <br />0 <br />A <br />Al <br />