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20742 WELL/PUMP PERMIT -P ✓ 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> rn <br /> JOB ADDRESS 4q06 ASHLEY RD. CITYZP STOC,KTQN CA 9 ci21 2 D <br /> 0 <br /> CROSS STREET COL P, APN 0,91;_1 0-206 PARCEL SIZE 0- 5 9 LAND USE APPLICATION# A <br /> m <br /> OWNER NAME PRIP41TI-WO C' wz LESS' � ! PHONE 209-93$—gagl N <br /> OWNER ADDRESS 4S� .T()HN KAMPS WAY CITY/STATE/ZIPRIp.jt.0)N r-A 95366 <br /> CONTRACTOR Delta Pump_GTncKTnN ARMATURE & MOTOR WORKS ffA61L. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE . ❑ C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08/1 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE CX*mestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: Water ystem ame Contact Name or Phone Number <br /> TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br /> ❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #ofborings ❑ Geotechnical # I <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair ReCCT <br /> ❑ New Pum ❑ Pum Replacement um Repair ❑ Raise Well CasingC <br /> WELL CONSTRUCTION Ch <br /> Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other Q cry Ale <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Siz 0AW i Iameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft yEALT_Nmx CNS, <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel ❑ Other 'gR7'M_—.,_ <br /> Grout Seal Depth ft ❑ Neat Cement(94 Ib bag/5-10 ga/water) ❑ Sand Cement sack mix17 gaall7ter <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other ❑ Retardant/AcceJerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stov Pipe <br /> PUMP bmersible❑ Turbine ❑ 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 !%T HE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPEN TION LAW . <br /> MIN UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED TITLE CEO DATE 9/5/18 <br /> _ <br /> PUMP/WELL IS LOCATED ON THE -, <br /> FRONT WEST SIDE OF THE HOUSE. <br /> 10 <br /> R - VISIBLE FROM THE STREET. BIG TREE <br /> .. NOLONGER THERE <br /> g�,� "',. ,_T <br /> AA <br /> DEPARTMENT U E ONLY <br /> Application Accepted By Date Area__gArq Employee ID#� <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By deki NAMM2 Date 'Z /Z_6 1 WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received he Amount Date Permit/ Invoice# Well ID# <br /> Codes Info By Cas Remitted I Service Re uest# <br /> bs° -3/4M F _t � <br /> EHD 43-06 <br /> 8/04/08 <br /> WELL/PUMP PERMIT <br />