Laserfiche WebLink
• WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN -REFUNDABLE PERMIT CALL 4O9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS Alvarado Avenue and Fargo Street Ao-goo CVrYt//zlr�Sttockton, California q'S� q <br />CROSS STREET Alvarado Ave and Fargo Street APN 115-300-02 PARCEL SIZE ('nyr / / LAND USE APPLICATION # <br />OWNER NAME Randy Bling 209473-1106 <br />OWNER ADDRESS 1701 West March Lane Suite D'(% CITY/STATE/ZIP Stockton, California 95207 <br />CONTRACTOR Krazan & Associates, Inc. 1 PHONE 559.348.2200 <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue CITY/STATEIZIP Clovis, California 93612 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE f C-57 C-61 D-09 Other NUMBER 499908 EXPIRATION DATE 10/31/2018 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />WENDED USE DomestictPrivate Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Pl.n. lumber <br />IYPE OF W ORK New Wait . Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Bodng(s) # or borings Geotechnical 5 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair -T1 —0-50 Feet) <br />New Pump Pump Replacement Pump Repair Raise Well Casino <br />Drilling Method Mud Rotary Air Rotary VAuger Cable Tool Push Point Other <br />Proposed Well Depth4'-5b 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 41/' in, Thickness/Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br />Grout Seal Dept%ft V/ Neat Cement (94 Ib bag/5-10 gal water) Sand Cement sack mW7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible. Turbine Other HP Pump Set It Standing Water Level 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 />,a118D11 24 AD OTICE R IRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SI k, - TITLE Managing Engineer I?ATE 3/15/2018 <br />R <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspedii" By <br />COMMENTS I7IL. <br />LA <br />M <br />D <br />A <br />RTMENT UjgE OIN Y <br />Datesm'-2ff Area Employee ID#JAI" <br />Date SPECIAL Well Permit <br />Date Ofq WAIVER Received <br />Date G bl 9 Constr4cted Well Depth ft <br />— ly /' /f <br />PE SC <br />Codes Info <br />Received eck#/Amount Date PermiU Invoice # <br />8 Remitted Service Re nest# <br />Well It7if <br />+x'332 19'(,, /� D 3'- 0 <br />EHD 43-08 WELL /PUMP PERMIT <br />4/30/12 <br />