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WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT L 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP <br /> 23223 S.Austin Road Ripon,on.CA <br /> D <br /> CROSS STREET ( APN 226-150-027 1 PARCEL SIZE AND USE APPLICATION# In <br /> A <br /> OWNER NAME Fredrik's Nursery I >`�W fCS 1��'ri/�U PHONE w <br /> OWNER ADDRESS 23223 S.Austin Road �� CITY/STATE/ZIP Ripon,California <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215W Dakota Avenue CITY/STATEIZJP Clovis.California 93612 <br /> LICENSE /C-57 ❑C-61 ❑D-09 ❑Other NUMBER 499908 EXPIRATION DATE 10.31.2018 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)LI Arsenic(4393) <br /> INTENDED USE Domestic/Private I.I Irrigation/Agricultural a Industrial Water Quality Monitoring IJ 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 Replacement Well a Well Alteration/Modificatlon I 1 Other <br /> Monitoring Wells) #of wells a Soil Boring(s) *of borings V Geotechnical 3 If of borings <br /> Out-Of-Service Well ❑Out-Of-Service Well Renewal i i Cross-Connection Repair 7T<7_=eeO <br /> New Pump Pump Replacement D Pump Repair a Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary 12 Air Rotary /Auger ❑Cable Tool 1 1 Push Point II Other <br /> r <br /> Proposed Well Depth,�5 -�10 ft Excavation in diameter Open Bottom LI Gravel Pack/Gravel Size in diameter <br /> I Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic 11 Stainless Steel D Other <br /> Grout Seal Depth(!S � Qft yd Neat Cement(94 Ib bag15-10 gal water) Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped i I Free Fall Other ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By ! Driller 11 Pump Contractor Li Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP Submersible Turbine ❑Other HP Pump Set It 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 /> INIMUM 48 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNS TITLE Managing Engineer DATE 09/26/2018 <br /> AR <br /> 8RoAn <br /> ZO18 <br /> I co <br /> UN <br /> N-r <br /> TMENT <br /> PA TMENTU E O L <br /> Application Accepted By D to G� ty Area Employee ID#� <br /> Grout Inspection By Date 11 SPECIAL Well Permit <br /> Pump Inspection By Date I i WAIVER Received <br /> Soil Boring Inspection By Date L / Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check Amount Date Permit/ Invoice# Well ID# <br /> Codes Info s Remitted ervic Re uest# <br /> O S <br /> EHO 43-06 revised 4114118 WELL/PUMP PERMIT <br />