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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 PERMIT CA <br />JoBADDRESS Alvarado Avenue and Elena Lane <br />CROSS STREET .J� APN <br />OWNER NAME Florsheim Homes, LLC <br />OWNER ADDRESS 1701 W. March Lane Suite D <br />CONTRACTOR Krazan & Associates, Inc. <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue <br />SUBCONTRACTOR Krazan & Associates, Inc. PHONE 559.348.2200 <br />SUBCONTRACTOR ADDRESS 215 W. Dakola Avenue CITY/STATE/ZIP Clovis. California 93612 <br />LICENSE /C-57 C-61 - D-09 [I Other NUMBER 499908 EXPIRATION DATE 10,31 2018 <br />953-7.697 FOR INSPECTIONS EXPIKEb 7 YEAR FROM UATE ISSUED <br />DcITvIZIP <br />Stockton, CA -0 PARCEL SIZE LAND USE APPLICATION # <br />PHONE 209.473 1106 <br />CITY/STATE/ZIP Stockton, CA 95207 <br />PHONE 559.3.18.2200 <br />CITY/STATE/2]P Clovis, California 93612 <br />DOMESTIC WELL SAMPLING: I 1 General Mineral/Coliform Bacteria (4391) I 1 Dibromochloropropane (4392) 1 1 Arsenic (4393) <br />NTENDED USE Domestic/Private -I Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well i i Replacement Well _1 Well Alteration/Modification 1 : Other <br />Monitoring Well(s) # of wells := Soil Boring(s) # of borings f Geotechnical 3 # of borings <br />I ' Out -Of -Service Well - Out -Of -Service Well Renewal I Cross -Connection Repair (10-20 feet) <br />I.1 New rump i I runup Meplacement -I <br />u raise vven <br />Drilling Method Mud Rotary f Air Rotary ./ Auger Cable Tool Push Point - Other <br />Proposed Well Depth ft Excavation in diameter I I Open Bottom I i Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad Steel . Plastic Stainless Steel Other <br />Grout Seal Depth ft y/ Neat Cement (94 Ib bag/5-10 gal water) i. Sand Cement sack mix/7 gal water <br />I i Bentonite (20% solids) i Other <br />Grout Placement Method Pumped Free Fall I Other Retardant / Accelerator (name) <br />PEDESTAL Installed By i Driller Pump Contractor Other <br />I -I Concrete Pedestal Ll Dimensions: Width ft Length ft Thick in 1 I Christy Box ❑ Stove Pipe <br />PUMP SubmersibleTurbine 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 />48 HQki}�AD�OTICE REC�IJIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 <br />SIGNED ��� TITLE Managing Engineer DATE 07/24/2018 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />!Iew <br />612018 <br />c <br />:NTUN�, <br />wR MENT U E OPOLY <br />ate Area Employee I D# JI" <br />UWj( ee v • G J� SPECIAL Well Permit <br />Date I WAIVER Received <br />Date Constructed Well Depth ft <br />� <br />mm�� e. <br />'�- <br />EHD 43-08 revised 4/14/18 WELL /PUMP PERMIT <br />