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20485 WELL/PUMP PE r2MIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED I JOB ADDRESS .1042 LEAF AVE CITY/ZIP STOCKTON 95207 CROSS STREET _ M FA DC) W APN/...Q77-38-01 77-38-01 1 PARCEL SIZE O —.5 4 -AND USE APPLICATION # OWNER NAME MARTA 2AT ( Fn•./ \�1%_��/ PHONE 209 507 2597 OWNER ADDRESS C M F Q `j CITYISTATE/ZIP_�/�j�� CONTRACTOR Delta Pump -qTC)( T<T0N ARMATURE & MOTOR WORKS 9"1&. 209-466-96 CONTRACTOR ADDRESS 646 S. California Street CITYISTATEIZIP Stockton, CA 95203 SUBCONTRACTOR ^ SUBCONTRACTOR ADDRESS LICENSE ❑ C-57 X C-61 O D-09 ❑ Other PHONE CITY/STATEIZIP NUMBER 724778 E.xPIRATIONDATE GEOGRAPHICAL INFORMATION' Coordinate X s Y Township Range Section INTENDED USE 0 Domestic/Private ❑ Irrigation/Agricultural ❑ industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization C Public Water System If different from Owner: Water System Name on ac ame or Prone Number TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification 0 Other C� Monitoring Well(s) # of wells C Sof(Bonn s # of bodnps gO ❑ Geotechnical ❑ Out -Of -Service Well 0 Out # � � -Of -Service Well Renewal ❑ Cross -Connection Repair' C New Pum mp Replacement D Pump Repair a� 0 Raise Well Casing WELL CONSTRUCTION Drilling Method 0 Mud Rotary C Air Rotary ❑ Auger ❑ Cable Tool 0 Push Point ❑ Other jjjN z S in Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size 0 Conductor Casing in diameter I in SAN SAN ameter Casing Depth ft Well Casing COUI Diameter _ in Thickness/Gauge/ASTM Sched ❑Steel [i Plastic ❑Stainless Steel ❑ Other ALT OEP7FNTAL `t—al Grout Seat Depth A it C Neat Cement (94 Ib bag/5-10 gat water) � Sand Cement sack mixR gal water water ❑ Bentonite (20% solids) 0 Other Grout Placement Method 0 Pumped ❑ Free Fall ❑ Other 0 Retardant / Accelerator (name) PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other 0 Concrete Pedestal Dimensions: Width ft Length ft Thick in 0 Christy Box 0 Stove Ploe IrVMP Xq Submersibleo Turbine O Other HP 1 Pump Set $ (L_— ft Standing Water Level 2 7_ ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS, MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS SIGNED y �.... _ ._c..<..._ TITLE CEO DATE 6/20/2018 PUM/WELL is located in the s back of the house next to the k 4 use. ` AL NOTE: THIS WAS AN EMERGENCY ISSUE OF NO WATER TO THE HOME. WE HAD TO PULL THE PUMP PRIOR TO YOU RECEIVING THIS APPLICATION. Louise Fornos Office Manager I ® a.,_ -u a� FPA TMENT USE O LY f ^ Application Accepted By Date Grout Inspection By Date Pump Inspection By Date Soil Boring Inspection By Date COMMENTS Area Employee to# PECIAL Well Permit WAIVER Received Constructed Well Depth ft EHD 43.06 8!04!08 WELL /PUMP PERMIT m D v X m