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T�i4,-1 Sut, i-L1-16 NA WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 - (209)468 NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSU JOB ADDRESS 2 7 51 1 F RT-- RT 26 ClrvlzlP LNDEN CA 9 5 2 3 6 _ CROSS STREET N SiiRI Lt. — a � APN 067-24-003 PARCEL SIZE 2 C-2 •3UZND USE APPLICATION# OWNER NAME EUGENE CAFE S SE PHONE,_U_4 8 1 -5 9 5 6 OWNERADDRESs _5475 VAN CITY/STATE(ZIP_GT(-)('K_ Tt1N rA 9;215 CONTRACTOR Delta Pp_GTnC'umnT\T ARMATTJRF MOT(1R WORKS 11"Eh. 209'-466-9625 CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP- Stockton, CA 95203 _ SUBCONTRACTOR PHONE _ SUBCONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 0 0-57 X C-61 0 D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08/16 GEOGRAPHICAL INFORMATION; Coordinates X Y Township Range Section INTENDED USE ❑ Domestic/Private CX1Xlgatlon/A9ricultural 0 Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization 0 Public Water System If dlfferentfrom Owner a or ys em ame Uontaot Name or f1hone Number TYPE OF WORK 0 New Well ❑ Replacement Well ❑ Well Alteration/Modification 0 Other _ 0 Monitoring Wells) #of wells 0 Sol]Boring(s) #of borings 0 Geotechnical #of borings 0 Out-Of-Service Well 0 Out-Of-Service Well o - MIPED 0 New Pum ❑ Pum Replacement um Repair e Ca WELL CONSTRUCTION Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push`AEl I �Btl 0 0 $-Otttp t - Proposed Well Depth ft Excavation In diameter 77,p � c G yell j in diamc 0 Conductor Casing In diameter / Conductor Casing D�pt (J�l (,v� b r, Well Casing Diameter_ in Thlckness/Gauge/ASTM Schad ❑byf-rwhwmap.Nl'f'f'v�d+ I�1��:.�{�. Grout Seal Depth ft 0 Neat Cement(94 Ib bag/5.90 gal water) ❑ Sand Cement 'f Pv YYFFPP Li �i��YYtl99sacK mW7 gal w_ ❑ Bentonite(20%solids) 0 Other Grout Placement Method ❑ Pumped 0 Free Fall 0 Other ❑ Retardant/Accelerator(name) PEDESTAL Installed By 0 Driller ❑ Pump Contractor 0 Other E. ❑ Concrete Pedestal Dimensions,Width ft Length ft Thick In ❑ Christy Box ❑ Stove Pipe PUMP C Wbmerslbleo Turbine ❑ Other HP 60 Pump Set-ZLSQ _-ft Standing Water Level A=4_5- __ 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH St JOAQUIN COUNTY'ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE CURRENT ANC ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT A AM IN COMPLIANCE WITH At WORKERS COMPENSATIO LAWS', I_ UM 24 OUR ADVANCE?, NOTICE REQUIRED FOR INSPECTIONS SIGNED TITLE CEO DATEY t� —I '4 PUMP/WELL Is located NOTE:Take HIGHWAY 26 EA5T past the town of LINDEN,at (?+ approx.323.62 ft.from dirt Escalon Bellota Rd.continue east on highway 26 for about 3.5 miles to a windmill on the North side of it t the highway. t IIKJNME Fa �'T 1LELJ14 1 L t,I E — t £ ,5} WINDMILL I DEPARTMENT USE ONLY Application Accepted By Date �� Area `i Em Io ee ID C- N Y Grout Inspection By_ Date SPECIAL Well Permit Pump Inspection By Date WAIVER Received Sol[Soring'lnspection By A Date Constructed Well De th _tq COMMENTS�� C- {'�/✓ �� Q C�,SJ G�� u��1=c'� ctiw l Zl�l PE Sc Received Check#L Amount Permit/ Codes Info' By Cash Remitted Date Service Re uest# Invoice# Well I❑# I�1Y�,1.. OJ' f� -I_`�.`� 1--�.0-•�ry `)%:V(; 7�1C'�'a EHD 43.06 — 8/04/08 WELL/PUMP PEP'G;