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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 /> JOBADDRESS 31.305 S_ KASs N RD CITY/ZIPTRACY 95304 m <br /> CROSS STREET DURHAM F F R R Y RD_ APN2 5 5-2 3-019 PARCEL SIZE 4 0 6 0 BAND USE APPLICATION# A <br /> OWNER NAMEA ; � 0e(��/"/ t(kU1 � l�.�Ij0HONE408 203 7487 <br /> OWNER ADDRESS 726 SAN MIGUEL AVE �? / CITYISTATEIZIPSUNNYVALE CAL 94085 <br /> CONTRACTOR Delta Pum1)_STnr KTnN ARMATURE <br /> & MOTOR WORKS 11114Q. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> I]SUBCONTRACTOR PHONE <br /> 15U8CONTRACTOR ADDRESS CITY/STATEJZIP <br /> (LICENSE 0 C-57 X C-61 C D-09 C Other NUMBER 72477$ EXPIRATION DATE-0 8/1 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Township Range Section <br /> INTENDED USC 0 Domestic/Private Irrigation/Agricultural Q Industrial C Water Quality Monitoring ' Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner, Water ystem Name <br /> villaut Name or Fjnone Number <br /> TYPE OF WORK 0 New Well 0 Replacement Well Well Alteration/Modification 0 Other <br /> G Monitoring 111e!!(s) #of wells Soil Boring(s) ;q of borings T- ) <br /> Geotechnical <br /> C Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair 9e <br /> C New Pume C Pump Re lacement XXump Repair 0 Raise Well Casing J�4N <br /> rrilling <br /> TRUCTION <br /> thod C Mud Rota Air Rota �JOAQurk <br /> Rotary Rotary D Auger 0 Cable Tool 0 Push Point 0 Other �IRotirw ; <br /> HEsi ry-�Cn _ <br /> Well Depth ft Excavation in diameter 0 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 Sched 0 Steel C Plastic D Stainless Steel 0 Other <br /> ` Grout Seal Depth ft C Neat Cement(94 lb bag/5-10 gal water) C Sand Cement <br /> Bentonite(20%a solids) ] Other sack mix/7 gal water. <br /> !Grout Placement Method D Pumped Free Fall C Other <br /> u Retardant/Accelerator(name) <br /> PEDESTAL Installed By CDriller Pump Contractor 0 Other <br /> D Concrete Pedestal Dimensions:Width ft Length ft Thick <br /> in a Christy Box 0 Stove Pipe <br /> (PUMP C Submersible X-Xrbine 0 Other <br /> HP_.50 _ Pump Set ft Standing Water Level 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 LIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSA N LAWS. <br /> MINIMUM 44 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED f TITLE CEO <br /> DATE 6/15/2017 <br /> I I I <br /> PUMP/WELL Is located <br /> approx. 2,069.62 ft. from <br /> Durham Ferry Rd. <br /> Nl` H h i <br /> T E VIC�.S <br /> �1 <br /> NOTE: <br /> PUMP SET&STANDING WATER LEVEL <br /> r IS UNKNOWN UNTIL THE JOB IS DONE <br /> r � l _ I <br /> I � <br /> DE ARTMENT U.SE� ONLY <br /> Application Accepted Sy e Date <br /> Aroa <br /> ,<< <br /> Grout Inspection By Date Employee IDtI oVtv� <br /> — SPECIAL W <br /> Pump Inspection By ell Permit If <br /> Date ^ P <br /> WAIVER Received <br /> Soil Boring Inspection By <br /> COMMENTS Date Constructed Well Depth ft <br /> PE SC Received ec Amount <br /> Codes Info 3• Cash RemittedDate Permit! <br /> Service Request# Invoice# Well 1D# <br /> �9 Z � i <br /> WPoo. q3I q <br /> EHD 43.06 <br /> 8104/08 <br /> WELL/PUMP PERMIT <br />