Laserfiche WebLink
19673 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 />IJOB ADDRESS 2 CITY/ZIP TRACY 95304 <br />ICROSSSTREET W. MIDDLE RD A NY -'Ir' -030 � PARCEL SI2EV--/zzZ/LgND SEAPPLICATION# <br />T <br />OWNER NAME HONE209 649 7627 <br />OWNER ADDRESS 20749 S. LAMMERS RD CITY/STATE/ZIP TRACY CA -3a304 <br />CONTRACTOR Delta Pumv gT0CKT()N ADMTTitDL MOTOR WORKS 1q*&- 209-466-96 <br />25 <br />CONTRACTOR ADDRESS 646 S. California Street CITYISTATE/ZIP Stockton, CA 95203 <br />SUBCONTRACTOR <br />PHONE <br />SU9CONTRACTOR ADDRESS CITYISTATEiZ1P f <br />LICENSE C C-57 N C-61 a D-09 D Other NUMBER 724778 ExPiRATIONDATE08/17 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Township Range Section <br />INTENDED USE 0 DOmestiC/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />G Public Water System <br />If different from Owner: Water ys em Name <br />�UCA Name or one Number <br />TYPE OF WORK C New Wel( 0 Replacement Well 0 Well Alteration/Modification 0 Other <br />G Monitoring Wells) # of wells D Soil Boring(s) # of borings L: Geotechnical # of borings <br />Out -Of -Service Well 0 Out -Of -Service Well Renewal 0 Cross -Connection Repair <br />0 <br />"--..Pump C PumD Reniacamant _m o,,,.,., o,...-:_ <br />Drilling Method C Mud Rotary C; Air Rotary 0 Auger D Cable Too] 0 Push Point 0 Other <br />Proposed Well Depth it Excavation in diameter 0 Open Bottom D Gravel Pack/Gravei Size in diameter <br />C Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter —in Thickness/Gauge/ASTM Schad <br />D Steel ❑Plastic D Stainless Steel D Other <br />Grout Seal Depth ft 0 Neat Cement (94 Ib ba';5-10 gal water) C Sand Cement <br />O BentonAe (20% solids) D Other sack mixl7 gal water <br />Grout Placement Method 0 Pumped 0 Free Fall 0 Other <br />0 Retardant /Accelerator (name) <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft I-nn}h <br />Z. uomersible0 Turbine G OtherHP .. J_ Pump Set ft Standing Water Level tt <br />_ <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONEIN 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 COMPEN <br />MINIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED L ,2� TITLE CEO <br />DATE 7 1 A / 7 QI '7 <br />I I 1 <br />PUMP/WELL Is located,,_ <br />i approx. 113.65 ft. north of <br />the Hay barn. The trees are µ <br />no longer there. <br />NOTE: <br />PUMP SET Q. STAN` Iro '•'' _ <br />IS UNKNOWN UNT <br />Application Accepted Sy <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />EHD 43.06 <br />8/04!08 <br />HAY BARN <br />.. . <br />_ Date <br />Amount <br />-21411 4-77 r"' 17 <br />Date <br />N <br />m <br />0 <br />U <br />M <br />m <br />N <br />Res <br />vvAIVER KeCelved <br />Constructed Well Depth ft <br />test # Invoice # <br />0-1 <br />Well ID# <br />WELL /PUMP PERMIT <br />