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--18607 WELL/PUMP PERMIT <br />,N JOAQUIN COUNTY ENVIRONMENTAL HEALTFI DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />JN -REFUNDABLE PERMIT CALL (209) 953.7697 FOR INSPECTIONS FXPIRPS 1 YPAR rpnm I7ATF IGSllrn <br />a ADDRESS 876 S PRIEST RF)CITY/zIPFRENCH CAMP 95231 <br />.OSS STREET����,� �P4�RGA <br />T–APN _ 193-14-016 PARCEL SIZE 0 . 3 GLAND USE APPLICATION # <br />VNER NAME VERONICA R URRO ,A PHONE 510-712-2440 <br />VNER ADDRESS SAME CITY/STATE/ZIP <br />INTRACTOR Delta_ Pump-STnrKPnN ARMA'T'URF & MOTOR WORKS 1"Q. 209-466-9625 <br />INTRACTORADDRESS 646 S. California Street CITYISTATEIZIP Stockton, CA 95203 <br />BCONTRACTOR <br />SCONTRACTOR ADDRESS <br />;ENE ❑ C-57 X C-61 <br />C' D-09 ❑ Other, <br />NUMBER <br />CITY/STATEIZIP <br />PHONE <br />EXPIRATION DATE 08/1- 1 <br />:OGRAPHICALINFORMATION: Coordinates X Y Township RangeSection <br />I L'IVVL'U „�� ,�ue,,,Csucrrnvate u IrrigaaoniHgricuitural u Inaustrlal ❑ Water Quality Monitoring 0 Soil Sampling/Characterization <br />0 Public Water System <br />If different from Owner: water System Name Uontact Name or Phone Numl5er <br />PE OF WORK o New Well ❑ Replacement Well 0 Well Alteration/Modification ❑ Other <br />❑ Monitoring Wells) # of wells ❑ Soil Boring(s) f/ of borings 0 G ech tf of borings <br />❑ Out -Of -Service Well 0 Out -Of -Service Well Renewal ❑ Cross-Connec�i <br />❑New Pump ❑Pump Replacement �}Vump Repair _ ❑ Raise Well Cas t. <br />3L CONSTRUCTION --- <br />illing Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other R <br />oposed Well Depth ft Excavation in diameter 0 Open Bottom ❑ Gravel Pack/Gravel Size In deter <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thlckness/Gauge/ASTM Sched 0 Steel ❑ Plastic 0 Stainless Steel ❑ Other E Joq t <br />Grout Se ❑ Neat Cement (94 Ib bag/5-10 gal wafer) 0 Sand Cement Sack mi47 gaPE& <br />o s) 0 Other <br />out Plac -roe Fall ❑ Other ❑ Retardant / Accelerator (name) <br />:DESTAL i-JAr1'&' Hed 5f' Z7 ril7er 0 Pump Contractor ❑ Other <br />❑ Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br />imp ysp Submersible0 Turbine 0 Other HP --- 1_ Pump Set ft Standing ater Level d ft <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />)AQUIN COUNTY ORDINANCES, -STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />!RRENT AND ,ACTIVE WITH T E CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT .I AM IN COMPLlikNCE WITH ALL <br />ORKERS COMPENSA ON L41 AWS\ <br />224 I•IOUR ADVANCE N0TlGE-' RI Qf1lRt:l:) FOR INkaPECT IiON`a <br />ix TITLE `CED _ DATE 7/7/2016 <br />Application Accepted By it <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring'lnspection By <br />OMMENTS —_f\/10 G C_C _1,1 iCiC..2 n C. <br />u ate _ <br />Date <br />Date <br />�•f <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />U) <br />m <br />n <br />0 <br />m <br />N <br />E FD <br />2 2016 <br />rE�MY <br />1 2016 <br />L N.WTH <br />•nr�� <br />PE <br />Codes <br />SC <br />Info, <br />ReceivedChe <br />a <br />as <br />Amount <br />Remitted <br />Date <br />Permit/ r <br />Service Request VI <br />Invoice # Well ID# <br />��� <br />;,�� <br />2773f <br />?-�z-��, <br />S/oolz;�9IT <br />34108 - WELL /PUMP PERMIT <br />