WP0038985 - Laserfiche WebLink

Home Browse Search

20869 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 NUN-KEFUNDABLE PERMIT GALL ZU9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 5 2 8 5r_ �1 K I N GOON RE). CITY/ZIP __1 95242 CROSS STREROYAL , APN 055-14-004 PARCEL SIZE 'I q _ A _LAND USE APPLICATION # OWNER NAME PHONE(—� 5 OWNER ADDRESS 13436 N THOR TON RD- CITY/STATE/ZIPLOD!,A _95-24-2 CONTRACTOR Delta Pump-gmprKTnN ARMATURE & MOTOR WORKS 110Gh. 209-466-9625 CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 SUBCONTRACTOR SUBCONTRACTOR ADDRESS CITY/STATE/ZIP PHONE LICENSE . ❑ C-57 XC -61 0 D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/1 GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section INTENDED USE X Domestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization -Public Water System li different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification 0 Other ❑ Monitoring Well(s) # of wells 0 Soil Boring(s) #of borings 0 Geotechnical #afbodngs ❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair 0 New Pump ❑ Pump Replacement X Pump Repair ❑ Raise Well Casing WELL CONSTRUCTION Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other Proposed Well Depth ft Excavation in diameter 0 Open Bottom D Gravel Pack/Gravel Size in diameter ❑ Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter _ in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic O Stainless Steel 0 Other Grout Seal Depth ft ❑ Neat Cement (94 /b bag/5-10 gal water) ❑ Sand Cement sack mix17 gal water 0 Bentonite (20% solids) ❑ Other Grout Placement Method ❑ Pumped ❑ Free Fall 0 Other ❑ Retardant / Accelerator (name) PEDESTAL Installed By ❑ Driller ❑ Pump Contractor 0 Other ❑ Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe PUMP Submersible❑ Turbine ❑ Other HP Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. -NN M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS SIGNED -~:: - TITLE CEO DATE PUMP/WELL IS LOCATED APROXIMATELY 61.10 FT FROM RD. 'at 8 r - - r �.milk JM, D PA TMENT/U E NLY Application Accepted By Date Grout Inspection By Date Pump Inspection By Date f I Soil Boring Inspection By Date COMMENTS lid i W 1 M cya 0 M M M N N Area Employee ID#a�6 SPECIAL Well Permit WAIVER Received Constructed Well Depth ft PE Codes IZ — ! ZJW Amount emitted J OZ� Permit/ Service Request # UWW - s Zia d0n -- �Z 77 �wu� U) _ Area Employee ID#a�6 SPECIAL Well Permit WAIVER Received Constructed Well Depth ft PE Codes SC Info Received Cash Amount emitted Date Permit/ Service Request # Invoice # Well iD# WL6,5D A)� 3\to 11-5-�� BJP vu3��g5 tho 43.06 8/04!08 WELL /PUMP PERMIT