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C <br />WELL/PUMP PERMIT �5 " <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (20 9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 14700 W. Schulte Road (� CITY/ZIP Tracy, California <br />CROSS STREET APN .2,6`�� 7 �� PARCEL SIZE Iib, 1e'ND USE APPLICATION # <br />OWNER NAME SSOE Group IncO A � C -A, r��. �nei-',HONE <br />OWNER ADDRESS 567-298-4904 <br />1001 Madison Avenue /Q 01001 Madison Avenue L�i�aul weA i' itr CITYISTATE/ZIP To weA i'mt� CITY/STATE/ZIP Toledo, OH 43604�e��5bu�0� <br />CONTRACTOR Krazan & Associates, Inc. PHONE 559.348.2200 <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue CITY/STATE/ZIP Clovis, CA 93612 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE V C-57 C-61 D-09 <br />PHONE <br />CITY/STATEIZIP <br />NUMBER 499908 EXPIRATION DATE 10/31/2018 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water 6YStern Name on a ame or one um r <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br />MonitoringWell(s) # of Wells Soil Boring(s) S # of borings 5 # of borings <br />gO Geotechnical <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair — (TD -50 Ft ) <br />New Pump Pump Replacement Pump Repair Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary t Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth IID -54 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 2 in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depthifl%I�ft %Neat Cement (94 /b bag/5-10 gal water) Sand Cement sack mixf7 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 ft 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 />24 H DV N TICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE <br />Managing Engineer DATE 06/18/2018 <br />v_r <br />D <br />v <br />m <br />N <br />435 <br />R <br />:4 Y41, <br />V� <br />2 p Z�fB <br />VRo UZN co <br />UVry <br />qt <br />11164 <br />EQ <br />Application Accepted By <br />PSA TMENT USE QrNLY <br />Date <br />Area Employee ID#�/ <br />Grout Inspection By <br />Date <br />SPECIAL Well Permit <br />Pump Inspection By <br />Date <br />WAIVER Received <br />Soil Boring Inspection By6JiIA <br />Date <br />Constructed Well Depth ft <br />COMMENTS <br />PE Sc Received <br />Codes Info B <br />(Checkn> Amount Date Permit/Invoice# WeIIID# <br />Remitted Service Request(# <br />II <br />v — <br />EHD 43-06 WELL /PUMP PERMIT <br />4/30112 <br />