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17976 WELL/PUMP PERMIT <br /> SA0WJOAQUIN`000NTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 2.09 963-7697 1.01'x.INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> cn <br /> a <br /> JOB ADDRESS 331 S C'HERRYLAND AVE CITY/ZIP STOCKTON 95215 m <br /> D <br /> Q <br /> CROSS STREET WATERLOO RD. APN 087-09-021 PARCEL SIZE 0 - 9 4 LAND USE APPLICATION# m <br /> N <br /> OWNER NAME JOAN SYKES PHONE 412-337-2538 <br /> OWNERADDRESS SAME CITY/STATE/ZIP <br /> CONTRACTOR Delta Pump_.q T'nC'KTnN ARMATURE & MOTOR WORKS ffa@:. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑ C-57 X C-61 ❑ D-09 0 Other NUMBER 724775 EXPIRATIONDATE 08/�L' <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE X,,Pomestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> D Public Water System <br /> If different from Owner: Water System Name _______0_onTact Name or Phone Number <br /> TYPE OF WORK Q New Well 0 Replacement Well 0 Well Alteration/Modification ❑ Other <br /> 0 Monitoring Well(s) #of wells 0 Soil Boring(s) #of borings 0 Geotechnical #of borings <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump ❑ Pump Replacement g)?ump Repair ❑ Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool 0 Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched D Steel ❑ Plastic 0 Stainless Steel ❑ Other <br /> Grout Seal Depth ft ❑ Neat Cement(94 lb bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br /> ❑ Bentonite(20%solids) 0 Other <br /> Grout Placement Method D Pumped ❑ Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor 0 Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP ubmersible❑ Turbine ❑ Other HP 1 Pump Set 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 COUNT`( ORDINANCES, STATE LAVA'S, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED L.!CENSE 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 /> 10 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC'T'IONS <br /> SIGNED TITLE CEO DATE 1 1 /11 /2015 <br /> PUMP/WELL is located approx. <br /> 60 ft.from Cherryland Ave. <br /> Y4 <br /> 2 small singe I <br /> family dwellings - FP Vi O NEINTALHOLTH <br /> �? <br /> F E MI /S R I <br /> c ' <br /> DEPARTMENT USE N7 fLY �� /1� � <br /> Application Accepted By\ -Dato Area <br /> -- Employee IDA_ c: J <br /> Grout Inspection Bye� 42Date SPECIAL Well Permit <br /> Pump Inspectio y_ Date IZI1WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Dat Permit/ Invoice # <br /> Codes Info B Cash Remitted Service Re uest# <br /> v5 SP NJ3_2Nn I/ Eo <br /> 0 '2o S Zoe <br /> Ely"VAQ IN <br /> EHD 43-06 <br /> 8/04/08 H 0EPAR A4 Nr ERMIT <br />