Laserfiche WebLink
zn��ial d(an <br /> 18145 WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT I I <br /> 1 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 1,OR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Ln <br /> JOB ADDRESS _A545 SHIPPEE L CITY/zIPSTOCKTON 95212 D <br /> i p <br /> CROSS STREET 99 EAST FRONTAGE nAM085-30-00 <br /> — — M PARCEL SIZE n _ 9 A LAND USE APPLICATION# <br /> En <br /> OWNER NAME MOHAMMED - ESB 'VLK K��') PHONE 7 OA qg 6-`,4 6 2 N <br /> OWNER ADDRESS 1 3 0 4 E. HAMMER LANE CITYISTATEIZIS TO CK TON CA 95210 <br /> CONTRACTOR Delta Pump_.gTnrKToN ARMATURE & MOTOR WORKS 11MI. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITYISTATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE 0 C-57 X C-61 ❑ D-09 0 Other NUMBER 724778 EXPIRATION DATE 08/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE XI}Qomestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: Water System Name UontactName or Phone Number <br /> TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification 0 Other <br /> ❑ Monitoring Well(s) #of wells 0 Soil Boring(s) #of borings 0 Geotechnical #of borings <br /> 0 Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump 0 Pump Replacement giump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑ 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 /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel ❑ Other <br /> Grout Seal Depth ft 0 Neat Cement(94/b bag/5-90 gal water) ❑ Sand Cement sack mix/7 gal water <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller 0 Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP ggSubmersibleD 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 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 /> Y_..�;„l�liWIM 24 HOAR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED <.-� <br /> /":--^"- TITLE CEO DATE <br /> ^ m <br /> �. ID v <br /> F w 0/ D <br /> m <br /> � t N <br /> l.t s ,4 I • <br /> J <br /> � S <br /> 03 " ro n C <br /> `..:. �• . : w o <br /> S ] m <br /> 0 N n r <br /> C n Q r <br /> N f <br /> O T <br /> DI <br /> EPARTMENT USE O LY Eyr <br /> Application Accepted By Date 2 Area Employee I D# S(,A / .. <br /> qj qq <br /> Grout Inspection By _ Date PECIAL Well Permit <br /> Pump Inspection by - Date WAIVER Received <br /> Soil Boring Inspection By Date 1 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Che Amount Date. Permit/ Invoice# Well ID# <br /> Codes Info By Cash Remitted Service Re uest# <br /> $ 1570a1 -'2 3--RC1-l6 V OO'Ll)Al VV POOOala-1 a <br /> EHD 43-06 <br /> 8/04/06 WELL/PUMP PERMIT <br />