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­1 Y•i _j n mi Scan 5013 4M 'v <br /> 18246 <br /> WELL/PUMP PERMIT <br /> .SEAN 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 INSPECT'IOICi EXPIRES 1 YEAR FROM DATE ISSUED <br /> 0 <br /> JoB ADDRESS 7556 N- PERSHING AVE. , CITY/ZIP STOCKTON 95207 D <br /> a <br /> CROSS STREET R I VERA APN 077-33-025 PARCEL SIZE 0.3 3 LAND USE APPLICATION# M <br /> M <br /> en <br /> OWNER NAME ANTHONY KAVANAUGH PHONE 4085049196 <br /> OWNER ADDRESS SAME CITY/STATE/ZIP <br /> CONTRACTOR Delta Pump_,TnnKTnN ARMATURF & MOTOR WORKS 1"Q. 209-466-9625 <br /> ,CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95203 <br /> !SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-57 N C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08/11k, <br /> i <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE X Z ROMestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK ❑ New Well ❑ Replacement Well 0 Well Alteration/Modification ❑ Other <br /> ❑ Monitoring Wells) #of wells ❑ 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 IXBSump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION j <br /> Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ 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/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel ❑ Other <br /> Grout Seal Depth ft ❑ Neat Cement(94/b bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> !PEDESTAL Installed By ❑ Driller 0 Pump Contractor 0 Other <br /> i ❑ Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box 0 Stove Pipe <br /> LPuMP <br /> XX Submersible❑ Turbine ❑ Other HP__1_ Pump Set---5-3—ft Standing Water Level 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 /> u LiRREN T AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE: LICENSE BOARD AND THAT 1 ANI IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> 4'tlM _ "0 HOUR 1-%DVANCH NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED �+�` '—r- � TITLE CEO DATE 3 Z 1 1 /2016 <br /> Nip <br /> NONNI <br /> NONE <br /> Noun <br /> DWELLING <br /> PUMP/WELL lis located behind <br /> s, the house approx.25 ft.from ` , <br /> • <br /> \® <br /> the back of the house E® <br /> NJ MEN <br /> ai NWWNM12016 <br /> L HEALTH <br /> MEMNON mmomiu <br /> IMM1ENNM MEMOV,�� <br /> c�c FAir <br /> No /��O <br /> -- , 15? <br /> V >rN C <br /> DEPARTMENT USE0NLY <br /> I <br /> Application Accepted By Date cL 1161 Area Employee ID# t`7r--&� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth / ft <br /> COMMENTS_fC,° -/r4Sj�c� C^ pC� Civ/�.�.? r� ..rs� [�w sclf, l� di?✓4�'�S (1�R,1 rYl <br /> PE Sc Received Chec #/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B as Remitte Service Request# <br /> EHD 43.06 WELL/PUMP PERMIT <br /> 6/04108 <br />