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WP0039319
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039319
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Entry Properties
Last modified
11/20/2024 9:09:41 AM
Creation date
2/28/2019 8:34:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039319
PE
4382
STREET_NUMBER
24305
Direction
E
STREET_NAME
STATE ROUTE 4
City
FARMINGTON
Zip
95230-
APN
18705017
ENTERED_DATE
2/26/2019 12:00:00 AM
SITE_LOCATION
24305 E HWY 4
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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17788 WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA95205-6232-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS 768 _ W. FEDORA ST. C CITY2IP FRENCH CAMP 95231 <br /> CROSSSTREET SCl_LOCKHART APN 193-25-024 PARCEL SIZE 0.36 LAND USE APPLICATION# z <br /> OWNERNAME CLARENCE SILVA m <br /> PHONE408-858-4325 y <br /> OWNERADDRESS '.7'77(1 r1DTr1T.AS CITY/STATE/ZIP MILPITAS CA 95035 <br /> CONTRACTOR Delta Pumv —STOCKTON ARMATURE & MOTOR WORKS PHONE. 209-466-9625 <br /> Co CTORADDREss 646 S. California Street CITY/STATE/LP _ Stockton. CA 95203 <br /> SU NTRACTOR <br /> PHONE <br /> USCONTRACTOR ADDRESS /STA ZIP y <br /> LICENSE ❑C757 X C-61 0 D-09 D Other R 72 EXPIRATION DATE 08/116 <br /> GEOGRAPHICAL INFORMATION; Coordinates X Y Township_ Range SSCtIOn <br /> INTENDED USE !kRomestic/Pr-vats 0 Irrigation/Agricultural D Industr onitoring ❑Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner. a ys e• on c ame or Phone NUMDer <br /> TYPE OF WORK ❑New Well 0 Replacement Well ❑ II Altera n anon ❑Other <br /> ❑Monitoring Well(s) #of we ❑5 oring( #of borings D Geotechnical #of borings <br /> ❑Out-Of-Service Well Out- rvi Well Renewal ❑Cross-Connection Repair <br /> 0 New Pum ❑Pum Re --cementP pa r 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary Air Rotary 0 Auger ❑Cable Tool ❑Push Point D Other <br /> Proposed Well Depth Exca tion In diameter 0 Open Bottom D Gravel Pack/Gravel Size In diameter <br /> D Cc uctor Casing In mete / Conductor Casing Depth ft <br /> Well Casing Dianne Thlcknes auge Schad D Steel 0 Plastic 0 Stainless Steel ❑Other <br /> Grout Seal Depth ea ment(941b beo-10 gal water) D Sand Cement sack mlx/7 gal water <br /> D Bantonite(20°o lids) ❑Other <br /> Grout Placement Method 0 Pumped Free Fall 0 Other ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller Pump Contractor D Other <br /> ❑Concrete Pedestal Dimensions:Wldth ft Length ft Thick In 0 Christy Box D Stove Pipe <br /> PUMP CKRubmersible0Turbine ❑Other HP. I Pump Set 82 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.1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> INIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED "XL/ <br /> TITLE CEO DATE 9/17/2015 <br /> Pump/Well is located behind the <br /> FRONT SINGLE FAMILY +` <br /> front house along the back fence DWELLING 768 W.FEDORA <br /> that separates the front and back <br /> -yxs houses.Approx.8 ft.from the East }' - <br /> fence. a'F. <br /> c <br /> SINGLE FAMILY DWELLING <br /> 777 W FFnOR4 <br /> 2 - ALTH <br /> fC IT11 Ur'dg <br /> ^ DEPARTMENT USE ONLY <br /> Application Accepted ByAt� Date LF� f Area 'V�A Employee <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soll Boring'lnspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Recalvedeck#/ Amount Permit/Codes Info B Date <br /> Cash Remitted Service Request# Invoice# <br /> t o -5&&0731 FZ- SqN J 2?O <br /> o N A TY <br /> EHD 43-09 <br /> 9/04108 WEL ERMIT <br />
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