Laserfiche WebLink
ml Scan 511VIIIfl" <br /> 18246 @VELL!PUMP PERMIT" <br /> SAN,JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCK70N CA 95205-6232 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL. 209 95:34697 FOR INSPECTIONti EXPIRES 1 YEAR FROM DATE ISSUED <br /> i � <br /> Joe AooRI=Ss 7556 N- PERSHING AVE. . CITYIZIp STOCKTON 95207 <br /> n <br /> CROSS STREET RIVERA APN 077-33-025 PARCEL SIZE 0- 33 LAND USE APPLICATION# <br /> m <br /> N <br /> OWNER NAME ANTHONY KAVANAUGH PHONE 4 0 8 5 0 4 91 96 <<' <br /> OWNER ADO RESS SAME CITY/STATEIZIP <br /> CONTRACTOR Delta Pum _ KS MNQ. 209--466-9625 <br /> CONTRACToRAoDREss 646 S. California Street CITYISTATEIZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE 0 C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE X2 fomestic/Private ❑ Irrigation/AgriCultura1 ❑ Industrial ❑ Water Quality Monitoring n Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Cwner: Water System Name Uontact Name or Phone Nurrer <br /> TYPE OF WORK ❑ New Well 0 Replacement Well ❑ Well Alteration/Modification D Other <br /> ❑ Monitoring Wells) #of wells 0 Soil Boring(s) #of borings ❑ Geotechnical it of borings <br /> 0 Out-Of-Service Well ❑ Cut-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> D New Pump ❑ Pump Replacement IXKrrip Re air 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method C Mud Rotary 0 Air Rotary C Auger 0 Cable Tool ❑ Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gaoga1ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel fl Other <br /> Grout Seal Depth ft C Neat Cement(94 Ib bag/5-10 gat water) 0 Sand Cement sack mix17 gal water <br /> ❑ Bentanite(20%solids) 0 Other <br /> lGrout Placement Method ❑ Pumped ❑ Free Fall ❑ Other D Retardant I Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor 0 Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length ft Thick in C Christy Box ❑ Stove Pipe <br /> PUMP XX Submersible❑ Turbine ❑ Other HPC_ Pump Set 3 ft Standing,WaterLevel 26 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. 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 /> Iar ; 'FOR INSPEC" RONiL �lt � �t <46 �= : t2a <br /> SIGNED �w--'F' �. l"" __. <br /> TITLE CEO DATE 3/11 /2016 <br /> a <br /> DWELLING <br /> PUMP/WELL lis located behind <br /> the house approx.25 ft.from <br /> the back of the house ff <br /> V ED <br /> 2016 <br /> &14A L HEALTI{ <br /> .q � 1S <br /> V. _ r I 4 <br /> CO <br /> NAY <br /> DEPARTMENT UJSE ONLY �F/L✓� <br /> Application Accepted By _ Date l l IL �� Area Employee ID# <br /> Grout Inspection By Date SPECIALWell Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Chec #! ' Amount Permit/ <br /> Codes Info B as Remitted Date Service Re uest# Invoice# Well ID# <br /> EHD 43.96 WELLIPUMP PERMIT <br /> 81©4108 <br />