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20198 <br /> - < WELL/PUMP PERMIT <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 /> co <br /> JOB ADDRESS 1R1-�$ F._ ( nPPF.RnDnT_Tc RD CITY/ZIP T,TND PN CA 95 2 36 m <br /> CROSS STREET DR A TttS R D_ APIV 1.-83-21 —0Q PARCEL SIZE _LAND USE APPLICATION# � <br /> OWNER NAME J "SANGUINETTI PHONE 483 4921 <br /> OWNERADDRESS SME/ o `��� ( , II�S J� CITY/STATE/ZIP ZMdell C"� <br /> CONTRACTOR Delta Pj=_ST(l('K'Tc)N AgmAripugp, & MOTOR AORKS M16Q. 209-466-962 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 0 C-57 X C-61 0 D-09 ❑ Other NUMBER 724778 EXPIRATION DATE_ 081 1Q p <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE (X5[omestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring ❑'Soil Sampling/Characterization <br /> C Public Water System <br /> If different from Owner water 6ystern Name Contact Name or Phone Numuer <br /> TYPE OF WORK ❑ New Well 0 Replacement Well ❑ Well Alteration/Modification 0 Other <br /> O Monitoring Well(s) #of wefts 0 Soff Sorin s #of borings NT <br /> 9O ❑ Geotechnical <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal ❑ Cross-Connection RepairCE'VcD <br /> w Pump 0 Pump Replacement 0 Pump Repair 0 Raise Well CasingC <br /> WELL CONSTRUCTION 2�fg <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel <br /> S.'uv QV iN gf�er <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft 1, L T114R E rTAL <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Schad 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br /> MENT <br /> Grout Seal Depth ft ❑ Neat Cement(94 lb bag/5-10 gal water) 0 Sand Cement sack mix/7 gat water <br /> 0 Bentonite(20%solids) 0 Other <br /> Grout Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> C Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy pox 0 Stove Pipe <br /> �] <br /> PUMP =SUbmersibleO Turbine 0 Other HP 3 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 /> MINIWO 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED ` TITLE CEO <br /> DATES 1 9/2018 <br /> PUMP/WELL is located approx.. <br /> �. <br /> 450.40 ft. from Copperopolis rd. <br /> under the trees next to the house. <br /> � r f n � i+•. �� � 1 <br /> 4 p.. <br /> Et H 1.` . HOUSE <br /> NOTE: NEW WELL WITH A NEW PUMP. WILL NOT z' <br /> HAVE THE STATIC WATER AND PUMP SETTING ` # , <br /> INFORMATION UNTIL THE JOB IS DONE. "t <br /> D PARTMENT U E NLY <br /> Application Accepted By Date Area Employee ID# <br /> J�" <br /> Grout Inspection By Date 4_6_ 11 Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC' R�cpived Che Amount Date Permit/ <br /> Codes Infd. ash Remitted Service Re uest# Invoice# Well ID# <br /> 6 3006 Pov 3�O 7� <br /> EHD 43-06 <br /> 6/04= WELL/PUMP PERMIT <br />