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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 /> JOB ADDRESS 6120 W Durham Ferry Rd CITY/ZJP Tracy 95304 <br /> CROSS STREET E of N Christmas Rd APN 253-250-26 PARCEL SIZE2Li�_LANO USE APPLICATION# <br /> OWNER NAME Roca Ranch Inc cin Jack Rose PHONE 831-0962 <br /> OWNER ADDRESS P.O. Box 83 CITY/STATE/ZIP Tracy CA 95378 <br /> CONTRACTOR Hennings ULps,"ing Co., Inc. PHONE 209-545-1185 <br /> CONTRACT RAO 9 d CITY/STATE/LP Modesto, CA 95356 <br /> SuBCO R PHONE <br /> SUBCO OR ADDRESS CITY/STATE/ZIP <br /> LICENSE x C-57 C-61 D-09 Other NUMBER 290813 EXPIRATION DATE 05-31-2017 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section <br /> INTENDED USE x DomesticlPrivate I Irrigation/Agricultural Industrial Water Quality Monilonng 'Soil Sampling/Charas enzation <br /> Public Water System <br /> If 6(ferent from OwnerWa er Syslem Name Lorlact Name or ane Number <br /> TYPE OF WORK x-+UZU-I:Wl Replacement Well L Well Alteration/Modillcation Other <br /> "i Monitoring Well(s) #of wells Soil Bonng(s) #of borings Geotechnical a or bonnOs <br /> 7 Out-Of-Service Well Out-Of-Service Well Renewal J Cross-Connection Repair <br /> 7 New Pump Pump Replacement - Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method x Mud Rotary Air Rotary Auger r. Cable Tool J Push Point Other <br /> Proposed Well Depth 300 n Excavation 14 in diameter D Open Bottom x Gravel Pack/Gravel Size No.6 in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It Sand pack <br /> Well Casing Diameter 8 in Thickness/Gauge/ASTM Sched SDR26 ':!Steel x Plastic Stainless Steel I Other <br /> Grout Seat Depth ?fl(1 ft Neat Cement(94 Ib bag/5-10 gal water) i Sand Cement sack mix(7 gal water <br /> x Bentonite(20%solids) Other <br /> Grout Placement Method x Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By - Driller x Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width ft Length R Thick in I Christy Box Stove Pipe <br /> PUMP Submersible. Turbine Other HP Pump Set ft Standing Water Level ft <br /> 1 HEREBY CERTIFY THAT 1 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 NOT E R I D FOR INSPECTIONS <br /> SIGNED TITL S f DATE <br /> r <br /> I V;71 -711 Al �E E/N�bT <br /> f VC <br /> V 2 3 2016 <br /> RUIN <br /> I"lot H 4e qR Al- <br /> Nr <br /> ZZ <br /> E F1 611 <br /> DEPARTMENT USE O LY �7J J1n/�"�/yn/ <br /> Application Accepted By Date t t Area Employee ID# TIVy/'� """�� <br /> Grout Inspection By Dale SPECIAL Well Permit r <br /> Pump Inspection By Dale WAIVER Received <br /> Soil Boring in ection By Date Constructed Well Dep ttpy ^ ft <br /> COMMENTS L"I cs L�✓�C K tvY> Ll/LL <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info By Remitted Service Request# <br /> ov <br /> r ii z <br /> EHD 43-0E WELL/PUMP PERMIT <br />