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1952 WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY tNVIRONMENTAL 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 /> y <br /> JOB ADDRESS 2425 LUC I LLE AVE, CITY/ZIP STOCKTON 95209 <br /> 'v <br /> GROSS STREET_—DON APN-0 8 0—2 0—0 0 2 PARCEL SIZE O,8 4_LAND USE APPLICATION# <br /> OWNER NAME ULVADOR ALVERE Z PHONE 916-912-1553 (SON) <br /> OWNER ADDRESS 2425 LUCI LLE AVE. CITY/STATE/ZIP STOCKTON CA 95209 <br /> CONTRACTOR _Delta Pump 6T11CKTl)N ARMATURE & MOTOR WORKS ft113Q. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP _ Stockton, CA 95203 <br /> !SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE ❑ C-57 aX C-61 ❑ D-09 D Other NUMBER 724778 EXPIRATION DATE 08/11 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE 15komestic/Private ❑ irrigation/Agricultural ❑ Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> ❑ Public Water System <br /> It different from Owner: water 6YStern Name ContaCt ISIS....or one Number <br /> TYPE OF WORK 0 New Well 0 Replacement We!! 0 Well Alteration/Modification ❑ Other <br /> G Monitoring W911(s) #of wells L7 Soil Boring(s) #of borings u Geotechnical #of borings <br /> ❑ Out-Of-Service Well 0 Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> C New Pum2 ❑ Pump Re lacement Rfump Repair 0 Raise Well Casin <br /> WELL CONSTRUCTION <br /> Drilling Method C Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> C Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM a/ASTM Sched <br /> — g O Steel G Plastic ❑ Stainless Steel ❑ Other <br /> Grout Seal Depth ft ❑ Neat Cement(94 lb bag/5-10 gal water) C Sand Cement <br /> Bentonite(20%solids) ❑ Other sack mix/7 gal water <br /> Grout Placement Method 0 Pumped C Free Fall 0 Other <br /> ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By C Driller u Pump Contractor 0 Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe <br /> PUMP � bmersible❑ Turbine ❑ Other HP Pum Set <br /> P 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 /> IMUM 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED TITLE CEO DATE 5/1 1 /2 017 <br /> I - <br /> I <br /> PUMP/WELL is located <br /> approx. 181.42 from <br /> the road. <br /> ga— <br /> H <br /> �VieD <br /> NOTE: , -0, 1017 <br /> P!J!/P SFT Rt STANDING WATER LEVEL t <br /> IS UNKNOWN UNTIL THE JOB IS DONE ECOUN7b <br /> D E ART M E N T U S E O N L Y <br /> Application Accepted By 0� t Dato <br /> Area_'["L�/ Employee IDl/-��� �� � <br /> Grout Inspection By Date r'""-7'-'- <br /> SPECIAL Well Permit <br /> Pump Inspection By � Date Z �- <br /> WAIVER Received <br /> Soil Boring Inspection By Date <br /> COMMENTS fFn Constructed Well Depth ft <br /> Cx[� � Q!c c e,,, - <br /> x"11 '� r o I t (�-o <br /> r <br /> PE SC Received ec Amount <br /> Godes Info B Cash Date Permit/ <br /> Remitted Service Re uest# Invoice# Well ID# <br /> �° ' �6 ;2 z 0 �� sll��t t677 L/ <br /> EHD 43-06 <br /> 8/04/08 WELL/PUMP PERMIT <br />