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20535 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 4868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />NC N -REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES T YEAR FROM DATE ISSUED <br />I <br />Jos ADDRESS 4 0 CITYiLPsTO('KTnN <br />CROSS STREET 99 FRONTAGE APN 181-13-042 PARCEL SIZE —2-.-3,41-AND USE APPLICATION # <br />OWNERNAME JAMES ARMSTRON <br />' PHONE 481 -3852 <br />OWNERADDRESS SAME CITY/STATE/ZIP <br />CONTRACTOR Delta Puma 4T(1(`KT(1nT ARMATi7RF & Mt7T(�R pJt� S 11461A� 209-466-96?5 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stock_ ton, CA 95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CIT(/STA7E/ZIP <br />LICENSE 0 C-57 X C-61 0 D-09 0 Other NUMBER 72477$0 $ <br />E,XPIRATIOCI DATE_ >' <br />GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Township <br />INTENDED USE Range Section <br />tmestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring O Soil Sampling/Characterization <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 C New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br />O Monitoring Well(s)# of wefts O Solf Borings) # of bo"nes <br />❑ Geotechnical <br />C Out -Of -Service Well <br />❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />0 New Pump ❑ PumD RP.DIaramani a��,.,... D --- <br />JII/ In (� <br />Drilling Method G Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool G Push Point 0 Other SAN j0AQ(,/ly 4.Ul/,j <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom D Gravel Pack/Gravel S737 lze LTH <br />G Conductor Casing in diameter / Conductor Casing Depth ft �jv'[ <br />Well Casing Diameter— in Thickness/Gauge/ASTM Sched NI <br />❑Steel D Plastic 0 Stainless Steel 0 Other <br />Grout Seat Depth ft ❑ Neat Cement (94 Ib bag/5-10 gal water) 0 Sand Cement <br />0 Bentonite (20% solids) 0 Other sack mixR gal water <br />Grout Placement Method ❑ Pumped G Free Fall 0 Other <br />0 Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller ❑ Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft I Ani f k ,, :_ . _. <br />E Umr g(4(ibmersible❑ Turbine ❑ Other HP ,3 Pump Set -10 4 It Standing Water Levels h ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 <br />HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />TITLE CEO DATE 7 / 6 / 2 018 <br />01-1— yam'i <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />• SC Received <br />as Info g <br />EHD 43.06 <br />8/04108 <br />PAI <br />Date <br />Date <br />Date <br />Date <br />Date <br />PUMP/WELL is located approx. 140 ft. <br />from the road between the front and <br />back houses. The tree is no longer <br />there. <br />Area- i Lm Employee ID#d % <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />Invoice # I Well ID# <br />WELL /PUMP PERMIT <br />m <br />9 <br />X <br />m <br />