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9 <br />20642 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />NUN-KEFUNDABLE VERMIT <br />GALL (ZUV)90;5-1b91 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />7JOBADDRESS <br />1651 N . BEECHER <br />RD CITY/ZIP STO <br />_KION 95215 <br />CROSS STREET <br />HWY 26 <br />APN 103-02-009 PARCEL SIZE 10 7. 34ND <br />USE APPLICATION # <br />OWNER NAME <br />F&S SOLARI <br />_'�Jar­/ <br />PHONE 607-1078 <br />OWNER ADDRESS <br />4122 N. ALPINE <br />RD_ ule-Al CITY/STATE/ZIP STKN <br />CA 95212 <br />CONTRACTOR <br />Delta Pump_GTnnxmnN <br />ARMAT IRP & MOTOR WORKS <br />11AQ. 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP <br />Stockton, CA 95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE . I,, C-57 X C-61 0 D-09 ❑ Other, <br />PHONE <br />CITY/STATE/ZIP <br />NUMBER 724778 EXPIRATIONDATE 08/1� <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE ❑ Domestic/Private XXrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization <br />❑ Public Water System <br />If different from Owner: Water System Name Uontact Name or Phone Number <br />I YPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification 0 Other <br />0 Monitoring Well(s) #of wells 0 Soil Boring(s) #of borings ❑ Geotechnical of borings <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repai o <br />11 New Pump 0 Pump ReplacementXX7 Pump Repair ❑ Raise Well Casino 0 _ vlo <br />WELL CONSTRUCTION 101% <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool 0 Push Point ❑ Other <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/GravOeter <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched 0 Steel ❑ Plastic ❑ Stainless Ste> <br />Grout Seal Depth ft ❑ Neat Cement (94 Ib bagl5-10 gal water) ❑ Sand Cement sack mixl7 gal water <br />0 Bentonite (20% solids) 0 Other 37 <br />Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other r1 Rptarriant / Arrplprntnr /nnmal <br />PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br />❑ Concrete Pedestal Dimensions: Width It Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br />PUMP 0 Submersible XTVbine ❑ 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 COMPENSATIOWLAWS. /\ <br />SIGNED <br />R ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />TITLE CEO <br />DATE a.41 31/ 2 018 <br />TARTMENT U E N�LY <br />Application Accepted By Date ;7 Area Employee ID# /b/\JL <br />Grout Inspection By Date SPE IAL Well Permit <br />Pump Inspection By Dateb WAIVER R2CelV@d <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />Check#/ <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Re uest# <br />Invoice# <br />WellID#.,.• <br />X17- <br />os-� <br />313itD <br />YJ• V V <br />8/04/08 WELL /PUMP PERMIT <br />mm <br />D <br />0 <br />a <br />m <br />m <br />U) <br />