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20898 <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 /> JOB ADDRESS 2135 Waudman Ave. CITI•JZIP Stockton 95209 m <br /> CROSS STREET Thornton APN� -40 <br /> _PARCEL SIZE LAND USE APPLICATION# <br /> OWNER NAME Dean Morris m <br /> PHONE 209-473-3985 �? <br /> OWNER ADDRESS SAME CITY/STATEIZIP <br /> CONTRACTOR Delta Pumu_STnrKTnm ARMATURE & MOTnR WORKS WAQ. 209-466-962 <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 EXPIRATIONDATE 08/1° <br /> GEOGRAPHICAL INFORMATION: COoirdinateS X Y TOWrIShlp Range Section <br /> INTENDED USE OkDomestic/Private ❑ Irrigation/Agricultural ❑ Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: a er ystem ame Contact Name or one Number <br /> TYPE OF WORK 0 New Well 0 Replacement Well ❑ Well Alteration/Modification 0 Other <br /> 0 Monitoring Wells), #of wells 0 Soil Boring(s) #of borings #ofborings <br /> 0 Out-Of-Service Well ❑ Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> 0 New Pum2 0 Pump Replacement [XPump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> 'L <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool ❑ Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom 0 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 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br /> Grout Seal Depth ft ❑ Neat Cement(94 Ib bag/5-10 gal water) ❑ Sand Cement sack mix/7 gat 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 0 Pump Contractor 0 Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe <br /> PUMP R Submersible❑ 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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED :— TITLE CES <br /> .,., ��--- �:�•�b DATE_11 2 9/18 <br /> Aprox 119 ft from - <br /> Waudman AvP <br /> , <br /> „, ,, C6 U t <br /> br0 018 <br /> F <br /> EP RTMENT U E N�QL-Y a_NT <br /> Application Accepted By Date l!J Area Employee ID# A /J�,,,! <br /> Grout Inspection By 11l� t1 A Date SPECIAL Well Permit <br /> Pump Inspection By y Fti�1� �� 1111 h I N V�1 DatellffEM c WAIVER Received <br /> Sail Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Chec Amount Permit/ <br /> Codes Info B Cash Remitted Date Service <br /> Re uest# Invoice# Well IDA <br /> 4317 LP� 12 <br /> EHD 43-06 <br /> 8/04108 WELL/PUMP PERMIT <br />