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20230WELL/PUMP PERMIT �f 1 <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 />Joe ADDRESS 7651 F.- FicuT MTT F jar CITY/ZIPST'E112--12-W EA 95212 — <br />CROSS STREET H I LDRETH APN 063-040-12 PARCEL SIZE 3B--4-_9-AND USE APPLICATION # <br />OWNER NAME jGHN R t� �-rr t .r i -c� PHONF2 0 9 649-3470 <br />OWNER ADDRESS SAME CITYISTATE/ZIP <br />CONTRACTOR Delta Pump—_qTn(,T<anN ARMATljg & MOTOR WORKS ifalk. 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95203 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP l <br />LICENSE ❑ C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/1% <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE 40pmestic/Private 0 Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization <br />C Public Water System <br />If different from Owner: a er ystem am© on ac ame or one um er <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification C Other <br />O Monitoring Well(s) # of wefts O Soii Sorin9() s of bodngs <br />❑ Geotechnical <br />C Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />C New Pump RBump Replacement ❑ Pump Repair 0 Raise Well Casing�i�iiiL� e. <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool 0 Push Point ❑ Other^+, 2 2 2n4a <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom ❑ Gravel Pack/Gravel Si In diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft �gEIIy NM CQV <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched ❑ Steel D Plastic D Stainless Steel p Otrt�� D NMEN1- <br />Grout Seal Depth ft C Neat Cement (94 Ib bag/5-10 gal water) G Sand Cement_ sack mix /7 gal wa er <br />Bentonite (20% solids) 0 Other <br />Grout Placement Method ❑ Pumped ❑ Free Fall 0 Other ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller ❑ Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box 0 Stove Pipe <br />PUMP Submersible 0 Turbine ❑ Other HP �_ Pump Setft Standing Water Level ft <br />1 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) -AWS. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED s , 7 �//�/, ' TITLE CEO DATE <br />f <br />FPO" T <br />PUMP/WELL is located approx. s <br />467 ft. from 8 Mile Rd.�I`_r. <br />ff°­ <br />":: 1 7� <br />`v <br />Z.: <br />a�E <br />a � <br />a�E <br />2018 <br />DE ARTMENT �Sj�E O Y <br />Application Accepted By Date <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil BoringiRspection By Date <br />COMMENTS v L) rte, p P1A7 n s �Q <br />E <br />Info') <br />7 <br />:miveaI ane_ ��r- Amount Perm <br />By Cash as , a.ro� Date <br />Areae— Employee ID#_Wl" <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructedr Well Depth $ <br />3 � �(/ - I3/`y4 I I�3PC e 15-C, 7 <br /># I Invoice # I Well ID# <br />EHD 43.06 <br />8104/08 WELL /PUMP PERMIT <br />!M <br />1 <br />M <br />0 <br />a <br />m <br />m <br />6.Jfzf1/Y <br />