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20494 WELL/PUMP PERMIT <br />SAN 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 INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />2807 S. AIRPORT WAY rn <br />Joe ADDRESS CirymP S TOCKTON 952061 <br />�CROSS STREETit 1 i (' K ('R F K C r n r Tr aN 1 -� -� _ 0 2 0 0 6 PARCEL SIZE 18 - 8 LAND USE APPLICATION # m <br />OWNER NAME ALIAT.TTY PACKT Ir' l��i !'I ay� PHONEQ()�_ti�ti� <br />OWNERADDRESS 6880 NAVONF RTIC EO &V D%7Z CITY/STATE21P STQ KION A 95 1 <br />CONTRACTOR _ Delta Pump STOCKTON ARMATURF & MOTOR WORKS 11>U,-209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITYISTATEIZIP Stockton, CA 95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS <br />CrrYISTATE/ZIP <br />LICENSE 0 C-57 N C-61 0 D-09 0 Other NUMaI:R T <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />EXPIRATION DATE_ 0 8 / <br />Y Township Range Section <br />INTENDED USE ❑Domestic/Private O)r�gation/Agricultural ❑ Industrial ❑Water Quality Monitor ng 0 Soil Sampling/Character9zation <br />C Public Water System <br />If different from Owner. a er ys em ame <br />c ame or one um er <br />TYPE OF WORK 0 New Well 0 Replacement Well Cl Well Alteration/Modification O Other <br />G Monitoring WeU(s) # cf welts O Soil Soring(s) * of bonnps <br />C Out -Of -Service Well ❑ Geotechnical p� <br />0 Out -Of -Service Well Renewal ❑ Cross -Connection Repair �. <br />0 New Pumjp VfumpRe lacement 0 Pum2 Repair <br />UCTION O Raise Well Casing V <br />WELL CONSTRry <br />Drilling Method 0 Mud Rotary ❑ Air Rotary 0 Auger 0 Cable Tool 0 Push Point ❑ Other JUN L <br />Proposed Well Depth — ?�fR <br />p ft Excavation `—�' <br />in diameter 0 Open Bottom 0 Gravel Pack/Gravel OA iD diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft Rp U(/N <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched "EALTll pFOMENTAL <br />0 Steel 0 Plastic 0 Stainless Steel 0 Othet^` AR -r <br />Grout Seat Depth ft ❑ Neat Cement (94 Ib b -g -90 gal water �T — <br />J Sand Cement sack mixr7 gal water <br />❑ Bentonite (20% solids) ❑Other <br />Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other <br />0 Retardant /Accelerator (name) <br />PEDESTAL Installed By ❑ Driller ❑ Pump Contractor C <br />C Concrete Pedestal Dimensions: Width ft Other <br />Length ft Thick in ❑Christy Box ❑Stove Pipe <br />L1 -UMP Ri ubmersibleO Turbine ❑ Other HP <br />PUMP Set Ino ft Standing Water Level ft <br />THAT I HAVE PRE <br />1 HEREBY CERTIFY PARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. l ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITTI ALL <br />WORKERS COMPENSATION LAWS, <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED <br />TITLE CEO <br />DATE 6/20/18 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />Codes <br />1 <br />EMD 43-06 <br />8104108 <br />L <br />Amount <br />Remitted <br />i'L"!ay ; <br />