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4 °• TV, �7cgn <br /> 19284 <br /> r y 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 5347 F. $ MILE Rn- CITY/ZIP STOCKTON 95212 D <br /> 0 <br /> CROSS STREET OA KW T T-D RD- APN 059-26-077 PARCEL SIZE 2 _LAND USE APPLICATION# <br /> OWNER NAME JOHN FERREIRA ,fit , �j,�. f PHONE 209 649 3470 <br /> " <br /> OWNER ADDRESS 7651 E. 8 MILE RD. CITY/STATE/ZIP STOCKTON CA 95212 <br /> CONTRACTOR Delta Pump-gT0 (KTON ARMAT IRF P. MOTOR WORKS 1"1Ch. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08 1-1 <br /> t <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ❑kAmestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner: water 6ystem Name Contact Name or 11none Number <br /> TYPE OF WORK ❑ New Well D Replacement Well ❑ Well Alteration/Modification 0 Other <br /> u Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings #of borings <br /> ❑ Geotechnical <br /> ❑ Out-Of-Service Well 0 Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump D Pump Replacement mp Repair ❑ Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary ❑ Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched 0 Steel 0 Plastic 0 Stainless Steel D Other <br /> Grout Sea] Depth ft 0 Neat Cement(94/b bag/5-10 gal water) 0 Sand Cement sack mix/7 gal water <br /> ❑ Bentonite(20%solids) 0 Other <br /> Grout Placement Method D Pumped 0 Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor 0 Other <br /> C Concrete Pedestal Dimensions:Width ft Length ft Thick in 0 Christy Box ❑ Stove Pipe <br /> PUMP OXWmersibleD Turbine 0 Other HP__5 — Pump Set 1 4 8 ft Standing Water Level_8.7_.5 ft <br /> 1 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 /> IMUM 2 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED TITLE CEO <br /> DATE 311 51 017 <br /> i <br /> BARN ~ PUMP/WELL is located <br /> behind the garage near the <br /> trees. <br /> DMl <br /> .I <br /> GARAGE <br /> cry, <br /> MAIN A <br /> HOUSE F ANT <br /> FD <br /> �O M <br /> DEPARTMENT USE ONLY <br /> Application Accepted By J Date t AreaEmployee ID# t5-0�7(7 <br /> Grout Inspection By I Date SPECIAL Well Permit <br /> Pump Inspection By Date Q I LS}(I� WAIVER Received <br /> Soil Boring Inspection By Date . Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received C Amount Date Permit/ <br /> Codes Info B ;as Remitted Service Re uest# Invoice# Well ID# <br /> Z0 <br /> EHD 43-06 <br /> 8/04!08 <br /> WELL/PUMP PERMIT <br />