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0 <br />20660 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT <br />WELL/PUMP PERMIT t <br />1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />IVUI I-MEFUNDABLE PERMIT CALL 209 953-7597 FOR INSPECTIONS <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />12376 N. LOWER SACRAMENTO RD. <br />CITY/ZIP <br />LnD T 95242 <br />CROSS STREET <br />ARMSTRONG APN 058-09-023 <br />PARCEL SIZE 10 <br />LAND USE APPLICATION # <br />OWNER NAME <br />SHARON tAMETCALF 'Tr- <br />3/-�7tj <br />PHONE3 2 7- 3 4 6 7 <br />OWNER ADDRESS <br />SAME <br />CITY/STATE/ZIP <br />CONTRACTOR <br />Delta Pump--Tnc,xmnN ARMATURE & <br />MO'T'OR WORKS <br />Mf&. 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street <br />CITY/STATEIZIP <br />Stockton, CA 95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS <br />LICENSE , ❑ C-57 X C-61 <br />0 D-09 ❑ Other. <br />CITY/STATE/ZIP <br />NUMBER 724778 EXPIRATIONDATE 08/1 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE N)Domestic/Private D Irrigation/Agricultural ❑ Industrial 0 Water Quality Monitoring ❑ Soil Sampling/Characterization <br />❑ Public Water System <br />If different from Owner: Water S-y5te-m—lTaffig Contact Name or Phone Number <br />TYPE OF WORK ❑ New Well 0 Replacement Well ❑ Well Alteration/Modification ❑ Other <br />❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings ❑ Geotechnical #ofbo �^ <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />❑ New Pump ❑ Pump Replacement }TWPump Repair ❑ Raise Well Casino A/it, _ <br />—J 471 <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other�oq <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom 0 Gravel Pack/Gravel Size IYA �( <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft p�F <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched ❑ Steel 0 Plastic 0 Stainless Steel 0 Other <br />Grout Seal Depth ft 0 Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack mixR gal water <br />0 Bentonite (20% solids) ❑ Other <br />Grout Placement Method ❑ Pumped 0 Free Fall ❑ Other ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By ❑ Driller 0 Pump Contractor ❑ Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in 0 Christy Boz ❑ Stove Pipe <br />PUMP Rkubmersibleo Turbine 0 Other HP Pump Set ft Standing Water Level 57 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED TITLE CEO DATE 8/6/18 <br />PUMP/WELL Is located approx. <br />311.28 ft. from the road under the <br />tree. +' <br />NOTE: THIS WAS AN EMERGENCY ISSUE OF NO WATER <br />TO THE HOME. WE HAD TO PULL_ THE PUMP PRIOR TO YOU <br />RECEIVING THIS APPLICATION. <br />i .OYico Farm <br />Office Manz <br />CD <br />M <br />D <br />0 <br />V <br />m <br />y <br />V> <br />Application Accepted By <br />TMENT USP ONLY <br />Date <br />Grout Inspection By <br />Pump Inspection By <br />1 Date <br />! Date C <br />Soil Boring Inspection By <br />Date <br />COMMENTS <br />Invoice # <br />Area /"' % Employee ID#A�" <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE <br />Codes <br />SC <br />Info <br />Receiyed <br />„$ ' <br />heck <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Well ID# <br />3/-�7tj <br />EHD 43.06 <br />8/04/08 <br />WELL /PUMP PERMIT <br />