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w 20623 WELL/PUMP PERMIT 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 4-1 JOB ADDRESS 360 BOWMAN RD. CITY2IP FRENCH CAMP 95231 CROSS STREET r� APN 193-26-022 \ PARS CELSIZE 41 . 8 &ND USE APPLICATION # OWNER NAME TnNY Nn('F.TT / d i&lL ` Ills–)- &a i PHON4A2-6969 OWNER ADDRESS P.O. BOX 240 CITY/STATE/ZIPFRENCH CAMP CA 95231 CONTRACTOR Delta P=2_GTnCKT0N ARMAT TRF & MOTOR WORI:S II!q361>r. 209-466-9625 CONTRACTOR ADDREss 646 S. California Street CITY/STATE2tP Stockton, CA 95203 SUBCONTRACTOR PHONE SUBCONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 0 C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08�� GEOGRAPHICAL INFORMATION: Coordinates X Y _ Townshin Ramp Rection NTENOED USE ❑ Domestic/Private AXTrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization ❑ Public Water System If different from Ovmar a erys em ame Contact Name or Phone Number WMM Li I,IGw MM u meplacement well o well Alteration/Modification ❑ Other O Monitoring Wells) # of wells O Soil Boring(s) # ofborin s ❑Geotechnical #otborings C Out -Of -Service Well 0 Out -Of -Service Well Renewal ❑ Cross -Connection Repair � - D New Pump D Pump Replacement .khPump Repair_ _ 0 Raise Well Casino /A _ I Drilling Method ❑ Mud Rotary 0 Air Rotary 0 Auger ❑ Cable Tool 0 Push Point ❑ Other�j i Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel S z%,_ .31 lia ter ❑ Conductor Casing in diameter / Conductor Casing Depth ft J, / 70, Well Casing Diameter Grout Seal Depth _ in Thickness/Gauge/ASTM Sched 0 Steel D Plastic 0 Stainless Steel 004%R RU/,v AACS�,)."/ ft C Neat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sacit% gatyya e 0 Bentonite (20% solids) 0 ,Other T/t jF rT Grout Placement Method 0 Pumped ❑ Free Fail 0 Other D Retardant /Accelerator (name) PEDESTAL installed By 0 Driller 0 Pump Contractor 0 Other 0 Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box 0 Stove Pipe PUMP XXubmersibleo Turbine 0 Other HP Pump Set ft Standing Water Level 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 ' TITLE CEO DATE 7/25/2018 Application Accepted By Grout Inspection By Pump Inspection By Soil Boring Inspection By COMMENTS RTMENT U E ONL) Date Date _ Date nate Area Employee ID#� SPECIAL Well Permit WAIVER Received wlwrvn WELL /PUMP PERMIT rA mm 9 cr z