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RECEIVED <br /> ' a WELL/PUMP PERMIT 1 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-r�Y 1 1 1 1 2018 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISS E <br /> T <br /> JOB ADDRESS 18900 N. RIPON RD CITY/ZIP RIPON, 95366 ENVIR0V,tE.NTAL IIFACHI <br /> CROSS STREET HVVY 120 APN o PARCEL SIZE��LAND USE APPLICATION# U 1'. t IT I `I L N I <br /> OWNER NAME ARNEY CORBIN .169(k -1121PHONE 209.403.4783 <br /> OWNER ADDRESS 18900 N RIPON RD 1Q790 AcC 1I 'l CITY/STATE/ZIP RIPON, CA. 95366 <br /> CONTRACTOR N&S IRRIGATION, INC PHONE 209.599.3456 <br /> CONTRACTOR ADDRESS 215 W_ MAIN STREET CITYISTATE/ZIP RIPON, CA, 95366 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE C-57 I C-61 D-09 XOther C10 NUMBER 662732 EXPIRATION DATE 01/31/19 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring ,Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water bystern Name on a ame or one um r M �/ <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Molvc A� <br /> Dnitoring VJeii(s) 8 of A of borings #of bonngs wells Soil Bonng(s) i Geotechnical /♦� <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pum X Pum Replacement Pum Repair Raise Well CasingA/A <br /> WELL CONSTRUCTION S N 7 2018 <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other `�� U/,V <br /> Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size CSU <br /> Conductor Casing in diameter / Conductor Casing Depth It Wp Trk <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel i Plastic i;Stainless Steel i Other MEnrr <br /> Grout Seal Depth ft Neat Cement(94 lb I 10 gal water) Sand Cement sack ml gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method I Pumped i Free Fall Other i Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller __Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP XSubmersible. Turbine '::I Other HP__L — Pump Set _ft Standing Water Level <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOA COUNTY O INANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CU ENT D ACT WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> JO S C MPEN A ON L W <br /> I UM 4 VA OTICE REQUIRED FORA INSPECTIONS-PLEASE CALL(209)953/-72697 <br /> A <br /> SIGNED l TITLE /v(f/'Vl' /lKIl' DATE <br /> N <br /> E <br /> S <br /> Illy <br /> l " <br /> 10 <br /> EP RTMENT USE N L Y <br /> t <br /> Application Accepted By_ Date Area Employee ID#� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date - WAIVER Received <br /> Soil Borin I spection By Date Constructed Well Depth ft <br /> COMMENTS a I r-A A j�jilJ L( l�r� �T�t 1 (4 4 W4,10 itL9 /yWy� <br /> PE Sc Received Che Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B s Remitted Service Request# <br /> o .z <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 4/30/12 <br />