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20942 <br /> WELL/PUMP PERMIT <br /> SCAN 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 /> JOB ADDRESS 4919 California Ave. CIn.2ip Tracy 95304 m <br /> D <br /> CROSS STREET El Rancho RC1. APN 21 3-18-046 PARCEL SIZE 3.2 7LAND USE APPLICATION# A <br /> OWNER NAME Gabriel McCarty PHONE 209-627-5353 N <br /> OWNER ADDRESS SAME CITY/STATE/ZIP <br /> CONTRACTOR Delta Pump STnc,xmnN AnMATugp A MOTOR WORKS MQ._ 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 . 0 C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/1� <br /> GEOGRAPHICAL INFORMATION: COoIdinates X Y Township Range Section <br /> INTENDED USE CkDomestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner. Water ys em ame Contact Name or Phone Number <br /> TYPE OF WORK ❑ New Well 0 Replacement Well 0 Well Alteration/Modification ❑ Other <br /> 0 Monitoring Well(s) #of wells ❑ Soil Boring(s) #of borings # <br /> ❑ Geotechnical <br /> 0Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair V <br /> C. New Pump 0 Pump Replacement :9 Pump Repair ❑ Raise Well Casin <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary 0 Air Rotary ❑ Auger ❑ Cable Tool 0 Push Point ❑ Other SqN <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel�Cc lllj fteter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft TyQ'�MFN'L <br /> r. <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched 0 Steel 0 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 /> 0 Bentonite(20%solids) 0 Other <br /> Grout Placement Method 0 Pumped 0 Free Fall ❑ Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length It Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP OKSubmersible❑ Turbine 0 Other HP 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 I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> �,. -.M N19M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED_--�. TITLE CEO DATE 12/6/2 018 <br /> Pump is approximate 180 <br /> ft from California Ave. <br /> -41 <br /> I� <br /> •. tib' ���� � ��n <br /> Sy <br /> D PA, M E N T U SE OJN LY <br /> Application Accepted By ate Area ' Employee ID#j&W <br /> Grout Inspection By Date PECI L Well Permit <br /> Pump Inspection By 1 Date �1' WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received hec Amount Permit/ <br /> Codes Info B ash Remitted Date Service Re uest# Invoice# Well ID# <br /> EHD 43-06 <br /> 8/04/08 WELL/PUMP PERMIT <br />