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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMITe6j?,, „CALL(209)953-7697EQ POPECTIONIS EXPIRES 1 YEAR FROM DATE ISSUED <br /> U ur <br /> JOB ADDRESS SEC of River Islands Pkwy&Golden Valley Pkwy CITY/ZIP Lathrop/95330 m <br /> D <br /> 0 <br /> CROSS STREET Golden Valley Pkwy APN 191-19-064 PARCEL SIZE 16.95Auea LAND USE APPLICATION# m <br /> N <br /> OWNER NAME Watt McKee LLC }� �/ 1'rGPs.HONE n,_ 'a <br /> OWNER ADDRESS 2716 Ocean Park Boulevard,Suite 2025/PD6y” CITY/STATE/ZIP an al',Monnicaa/CA/90-4035W <br /> CONTRACTOR Salem Engineering Group,Inc PHONE (559)271-9700 <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/STATE/zIP Fresno,CA 93722 <br /> SUBCONTRACTOR Salem Engineering Group,Inc PHONE (559)271-9700 <br /> SUBCONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/STATE/ZIP Fresno,CA 93722 <br /> LICENSE XC-57 C-61 D-09 Other NUMBER 970772 EXPIRATION DATE 03/31/2020 <br /> GEOGRAPHICAL INFORMATION: Coordinates X 37.811410 y -121.298772 Township_ Range Section_ <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring XSoil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: water UYStern Nam Corned Nam or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well AlterationlModirication Other <br /> MonitoringWell(s) #ofwells XSoilBoring(s) 4 #of borings XGeotechnical 4 #ofborings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary XAuger Cable Tool Push Point Other <br /> Proposed Well Depth 5-30 ft Excavation 4,-6, in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth it <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth ft XNeat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mixR gal water <br /> Bentonite(20%solids) Other Ir <br /> Grout Placement Method Pumped XFree Fall XOther Retardant/Accelerator(name) <br /> PEDESTAL Installed Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width It Length ft Thidc in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WIT <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LIC 7 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ky O,y N <br /> WORKERS COM NSA N LAWS. FAM�`NO(/N <br /> NIM IVL O V TICE REQUIRED FOR NSPECTIONS-PLEASE CALL(209)95 7697 <br /> SIGNED TITLE DATE / MFNp <br /> EIVED <br /> P 12.2018 <br /> MEN-IAL HEALTH <br /> IT/SERVICES <br /> D AR MENT US O L�yz <br /> Application Accepted By Date (/ Areaploy..ID#' W <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> If <br /> 57 <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received hec AmoNit Date Perm"' Invoice# Well ID# <br /> Codes Info B Remitted Service R ,est# <br /> 'e"- lip gf4b6 _0k5 <br /> EHE 43-06 WELL(PUMP PERMIT <br /> 4/30/12 <br />