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2as26 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 CA44L 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS 4 BOWMAN RD. CITY/zIP FRENCH CAMP CA 95231 n <br /> v <br /> CROSS STREET MANTHEY APN 19 2-7 ti—C) PARCEL SIzE41 _R LAND USE APPLICATION# M <br /> m <br /> OWNER NAME TONY NOCETI PHONE 209 482 6969 <br /> OWNER ADDRESS P-n- BOX 340, FRENCH CAMP Rn CITY/STATE/ZIP 85321 <br /> CONTRACTOR Delta Pump-GTC CKTON ARMATt1RF. & MOTOR WORKS ff"Q. 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/IA <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE {Rkomestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: WaterSystern Name Contact Name or Phone Number <br /> TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification C1 Other AIIWPA <br /> ❑ Monitoring Well(s) #of wells ❑ Soil Boring(s) #ofborngs ❑ Geotechnical #ofb 'V <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> w Pum ❑ Pum Replacement ❑ Pum Repair ❑ Raise Well CasingOCTa <br /> WELL CONSTRUC ✓Oq <br /> Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other H CNV7&6-'NC <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size DN­ -'V <br /> er <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft ENj <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ 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) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP ❑ mersible❑ Turbine ❑ 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] AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATIO <br /> MINIMUM 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED_ TITLE CEO <br /> DATE 1 n/1 r;j 2 n_1 g <br /> a: "14 <br /> PUMP/WELL IS APPROX. 44F'. <br /> _ T FROM � <br /> CO { <br /> NCRETE PAD FOR ;__ � - THE NEW HOUSE.THIS IS A NEW <br /> THE NEW HOUSE WELL WITH A NEW PUMP.THE NEW <br /> HOUSE IS WHERE THE CONCRETE <br /> �► `..� : '` , PAD IS. <br /> K i <br /> - - -- I -r�T- <br /> EPARTMENT UEj NLY <br /> Application Accepted By Date Area Employee ID# <br /> Grout Inspection By ^ Date SPECIAL Well Permit <br /> Pump Inspection By Date t-) WAIVER Received <br /> Soil Boring Inspection By Date Cnstr acted Well Deptf ft <br /> COMMENTS I;. <br /> PE SC Received Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> f �isz� -W/112Z/ <br /> EHO 43.06 <br /> 8/04/08 <br /> WELL/PUMP PERMIT <br />