Laserfiche WebLink
s , <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1665 EAST HAZELTON AVENUE-STOCKTON CA 95205,(209)466.5420 <br /> NON-REFUNDABLE PERMIT CALL 209 963.7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> VI <br /> JOB ADDRESS 20102 DAYLIN AVENUE CITYIZIP ESCALONr CA 95320 <br /> CROSSSTREET JONES ROAD APN 247-130-27 PARCEL.SIZE I�j LAND USE APPLICATION 13 M <br /> OWNER NAME B..k"ARO, KICK x .T PHONE (209) 484-1010 VIM', <br /> OWNER ADDREEs 20102 DAHLIN ROAD CITY137AMZIP ESChLON, CF. 95320 <br /> CONTRACTOR MN7EPA AND SONS, INC. PHONE (209) 532-3.136 <br /> CONTRACTOR ADDRESS 143154 CUESTAA. COURT CJTY/STATEtZIP SONORA, CA 95370 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR AOORESS CITY/STATEIZIP <br /> LICENSE !_c C-57 --10-61 C D-09 Other NUMBER 425749 I ONDATE 7/31/16 <br /> GEOORAPHICAL INFORMATION: COordinete9 x Y S tlOn <br /> d Oomcrtn:�Privam D Irripa6on/AVftUHUral t7 Industrial C VVeterQUA1ity MOIlltO g i iah i e r{ratl <br /> - Public Water System RED <br /> r77- <br /> Ildlrtcrcm from Owgg r, W=r oyn cm Namm .: <br /> ey <br /> TYFF,iL RR Jew wall X Replacame nt Well L Wall AlteretlonlModtncatlon Other ��t���� <br /> _Monitonng WeII{a) #of yells l!Soil Boring(s) aor mdopa t- I p e1ted <br /> Or I n +1%� <br /> Out-Of-Service Well C�Out-Of-Service Well Renewal 7 Cross-C,'yT),,q,�'. t�}N �i SFC It " <br /> New Pum Pu replacement 11 Pump Repair ',R61Be We66ase,l[d� I iws1r;e <br /> W_FLL CoNaTRUCTION <br /> Drl111119 Method X Mud Rotary -Alr Rotary '"Auger 7 Cable Tool ri Push Point r, Other <br /> Propoacd Well Depth 300' ft Excavation 15" in diameter :J Open Bottom ?j Gravel PecWGrevel Size 3/8" in diameter <br /> _. Gonduotor Casing in diameter / Conductor CeAng Depth It <br /> Well CaSln9 Diameter A„V In ThleknaWGauge/ASTM Sehed .250 ?9 Stecl D Plastic 0 Stainless Steel p Other <br /> Grout Seal Depthi On ft -i Neal Cement(94 Ib bag'-'To Bay'WBteQ Send Cement_ Sack mIXIT gal Water <br /> ;KRentonite(20%solids) :i Other <br /> Grout Placement Method t Pumped ❑Free Fall G Other 'I Retardant)Accelerator(name) <br /> pf,Pr..TAI InsWticd By i_ Driller x Pump Contractor Other <br /> Concrete Pedestal'"Dimenelone:Wldlh ft Length ft Thick n - Christy Rox '"I Stove Pipe <br /> PUMP -Submersible:Turbine C 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 A ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS O PENSATION L t3, <br /> MU 24. VANCE NO CE REQUIRED P ! SP C 1 CALL(209)i/q75 -7 <br /> STONE TITIF DATE /! I <br /> r <br /> L43' 238I llpk� -I <br /> ' <br /> At <br /> z <br /> ) <br /> �gL:a <br /> 23e' <br /> 293' <br /> r � <br /> bEPARTMENT U E O LY n <br /> Application Accepted By Dale t.- Area Employee ID#�t,� / <br /> Grout Inspodar By Date [:I S ECI L Well Permit <br /> Pump Inspection By Date G WAIVER Received <br /> Sol]Boring Inspeclign By Data Constructed Well Dept <br /> COMM NTS L� O Off <br /> PE SC Received Cnec mount Date Permit/ Inv icg# <br /> Codee Info 13Y Cash Remitted Servlcc Re ucst it <br /> Received I ire-Nov. 24. 2015 9 : 09AM o- 0061 WELL IPVIdPPERMIT <br />