SR0074882 - Laserfiche WebLink

Home Browse Search

WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NUN -REFUNDABLE PERMIT CALL (ZUV) yb3-7b97 FOR INSPECTIONS EXPIRE5 1 YEAR FROM DATE ISSUED JOB ADDRESS 712 PEACH STREET CITY/ZIP LODI CROSS STREET COCHRAN RD. APN IN FRONT OF 027-160-06 PARCEL SIZe3680 SQ/ A OWNER NAME PG&E P OWNER ADDRESS 4040 West Ln CITY/STATE/ZIP StOC 95242 USE APPLICATION #_ 4E 209-932-6461 n / CA / 95204 CONTRACTOR PG&E PHONE CONTRACTOR ADDRESS 535 S Center St CITY/STATE/ZIP Stockton SUBCONTRACTOR PHONE SUBCONTRACTOR ADDRESS LICENSE ■ C-57 C-61 CITY/STATE/ZIP D-09 other NUMBER 339629 CA / 95203 EXPIRATION DATE 3 31-a--) �7 GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section NTENDED USE Domestic/Private J Irrigation/Agricultural 1 Industrial J Water Quality Monitoring Soil Sampling/Characterization Public Water System If different from Owner: Water bystem Name Gon act Name or F11none Number TYPE OF WORK ■ New Well Replacement WellWell Alteration/Modification ■ Other Anode Well Monitoring Well(s) # of wells Soil Boring(s) # of borings l Geotechnical # of borings Out -Of -Service Well [:; Out -Of -Service Well Renewal .I Cross -Connection Repair New Pump Pump Replacement Pump Repair I Raise Well Casing WELL CONSTRUCTION Drilling Method Mud Rotary Air Rotary Auger Cable ToolPush Point I Other Proposed Well Depth 200 ft Excavation 8 in diameter :I Open Bottom :.] Gravel Pack/Gravel Size in diameter Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter 44 in Thickness/Gauge/ASTM Sched Steel ■ Plastic i Stainless Steel Other Grout Seal Depth 50 ft Neat Cement (94 Ib bag/5-10 gal water) ■ Sand Cement 10.3 sack mix/7 gal water Bentonite (20% solids) I Other Grout Placement Method ■ Pumped Free Fall Other a Retardant / Accelerator (name) PEDESTAL Installed By ! Driller Pump Contractor I Other Concrete Pedestal '.IDimensions: Width ft Length ft Thick in I Christy Box ; I Stove Pipe PUMP Submersible:. Turbine ■ Other N/A HP Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMU 24 OU VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE Associate Distribution Engineer DATE��/7-/(� COCHRAN 8" ANODE WELL---:S�•4 50' kR MIT EXPIRED may have expired wit t g apleted ar insp cd - mental ltalth Divi N #718 "' RD. Application Accepted By EP RTMENT USE ONLY Dater ZL)� Area Employee ID#.0 Grout Inspection By �m �{ 3> m)> Pump Inspection By �o n� -17m Date -� C in �-. a 1-7 /.. . _ .� �. -� rn o w 1 a COCHRAN 8" ANODE WELL---:S�•4 50' kR MIT EXPIRED may have expired wit t g apleted ar insp cd - mental ltalth Divi N #718 "' RD. Application Accepted By EP RTMENT USE ONLY Dater ZL)� Area Employee ID#.0 Grout Inspection By Date Date ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Soil Boring Inspection By Date Con$tructed Well Depth ft �-. a 1-7 /.. . _ .� �. �_ n _ ^ _ -�.. _ -� r -� . r e —/ /_ - ?7 I . _ - — PE Codes SC Info Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Well ID# EHD 43-06 WELL /PUMP PERMIT 4/30/12