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20404 WELL/PUMP PERMIT PIA <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 /> JOB ADDRESS 7724 N- PFRsHTNr` AVE CITY21P STf=TnN f'A 95707 bmyyy <br /> CROSS STREET R T V A R A APN 7 7— 2—O 1 7 PARCEL SIZE n '1 LAND USE APPLICATION# C <br /> OWNER NAME MARY ALON O VA&LA" (-_t� PHONE2 0 9 q22-1 7 r;3 <br /> OWNER ADDRESS R W_ M(1NTFA> V AVE 1 CITY/STATEMP�c r�+ r�,� �A 252-4 <br /> CONTRACTOR Delta Pump GTDCRTQN ARMATURE & MOTOR WORKS 209-466-96 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATEMP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/Z1P <br /> LICENSE 0 C-57 X C-61 0 D-09 0 Other NUMBER 724778 EXPIRATIONDATE_ 08/% <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE _V)QOmestiC/Private 0 Irrigation/Agricultural O Industrial ❑ Water Quality Monitoring O'SOil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner, a or ys em ame L;ontact Name or Phone Number <br /> TYPE OF WORK ❑ New Well 0 Replacement Well 0 Well Alteration/Modification O Other <br /> 0 Monitoring WeU(s) #of welfs 0 SOI(BOrfng( ) borings s #of b #afborings <br /> ❑ Geotechnical <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> 0 New Pump OXF3pmpReplacement O.Purnp Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger ❑ Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom D 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 O Steel ❑ Plastic ❑ Stainless Steel 0 Other <br /> Grout Seat Depth ft O Neat Cement(94 lb bag/5-10 gal water) 0 Sand Cement sack mixf7 gal water <br /> 0 Bentonite(200/o,solids) 0 Other <br /> Grout Placement Method 0 Pumped ❑ Free Fall ❑ Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller 0 Pump Contractor 0 Other <br /> C Concrete Pedestal Dimensions:Width ft Length ft Thick in 0 Christy Box ❑Stove Pipe <br /> PUMP ONWbmersible0 Turbine O Other HP=====j== 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 BOARDAND THAT AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED /�%//�(�} � TITLE CEO <br /> DATE 2 2 /-10 <br /> PUMP/WELL is located on the ` <br /> north/east corner of the house <br /> 6 <br /> F I <br /> Ci <br /> L <br /> PATMENT USE ONLY <br /> Application Accepted By Date <br /> Area Employee ID#��,Y'=YI <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By � 1� �1 vvV �}� Date �' p l <br /> ---� �� <br /> Soli Boring Inspection By Date WAIVER Received <br /> COMMENTS 0 ttcc¢S) / WAIVER <br /> ted Well Depth ft <br /> PE SC Received Amount <br /> Codes Info B ash Date Permit/ <br /> Remitted Service Re uest# Invoice# Well ID# <br /> 9' J Poa 3 a39a <br /> EMD 43-06 <br /> 8/04/08 <br /> WELL/PUMP PERMIT <br />