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^� + IP 1 <br /> 18000-29545S. LEHMAN RD. <br /> 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 /> rn <br /> JOB ADDRESS 29945 S. LEHMAN RD. CITY/ZIP TRACY CA 95304 _i <br /> m <br /> D <br /> CROSS STREET W. L I NNE RD. APN 253-33-039 PARCEL SIZE 3 3 - 7&ND USE APPLICATION# � <br /> m <br /> OWNER NAME HAL ROBERTSON PHONE 914-1392 <br /> OWNER ADDRESS 27337 S. BANTA RD. CITY/STATE/ZIP TRACY CA 95304 <br /> CONTRACTOR Delta Pump_$TnCKTnN ARMATURE & MOTOR WORKS ENU. 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 ❑ Other NUMBER 724778 EXPIRATION DATE 08/iL' <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ❑ Domestic/Private q j(rigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner: Water bystem Name contact 175-me or PhUne Number <br /> TYPE OF WORK 0 New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br /> ❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings ❑ Geotechnical #of borings <br /> 0 Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump XTumpReplacement ❑ Pump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger 0 Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth ft Excavation in diameter 0 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 ❑ Steel ❑ Plastic ❑ Stainless Steel ❑ Other <br /> Grout Seal Depth ft 0 Neat Cement(94 lb bag/5-10 gal wafer) ❑ Sand Cement sack mix/7 gal water <br /> 0 Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall 0 Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller ❑ Pump Contractor ❑ Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP ❑ Submersible Turbine - HP 20() 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] AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MUM 2 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED TITLE CEO DATE1 1 /5/2015 <br /> MEN <br /> PUMP/WELL is located aprox.2,515 ft or �.� t. ,.�"` <br /> 0.5 mile from S.Lehman road to the - <br /> Farm blgs. <br /> back of the property. �,�.' <br /> MEN <br /> ENO <br /> MEN <br /> S Lehman �d` EON <br /> No <br /> C� YINN <br /> � INN <br /> INN <br /> ,,. .•.r. <br /> i <br /> - -- - TH <br /> P A R T M E N T U S/E O N L Y PERMIT/SERVICES <br /> Application Accepted By _ i.�J ' I f Area Fmnloyee In# <br /> Grout Inspection By Date I ( APECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received -` <br /> Soil Boring Inspection By Date Constructed Well Depth ^►� <br /> COMMENTS <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# NO ell ID# V <br /> Codes Info Remitted Service Request# O <br /> A30a�q I aOMER� i <br /> EHD 43-06 <br /> 8/04/08 WELL/PUMP PERMIT <br />