Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT #11213 600 E.Main Street-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES i YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> 11479 E. Ada Avenue CITY/Zip Stockton 95215 <br /> CROSS STREET Patton APN 103-270-06 PARCEL SIZE--L—LAND USE APPLICATION# <br /> OWNERNAM Home Sales Inc. c/o REO World PHONE Tim Frost949-720--7009 <br /> OwNERADDRESS 170 Newport Center Drive Ste. 150_ CrrY/STATE/ZIP Newport Beach CA 92660 <br /> CONTRACTOR Delta PUTP PHONE 209-466-9625 <br /> CONTRACTORADDREss 646 S. California Street CITY/STATE/ZrP Stockton CA 5203 <br /> i <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑C-57 X}'C-61 ❑D-09 ❑Other NUMBER 724778 EXPIRATION DATE 08/10 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ®DomesticMrivate ❑Irrigation/Agricultural ❑Industrial 13 Water Quality Monitoring Cl Soil Sampling/Characterization I, <br /> A ❑Public Water System <br /> If different from Owner: Water System Name coilwt Name or Phone Number <br /> TYPE OF WORK ❑New Well 0 Replacement Well ❑Well Alteration/Modification 0 Other <br /> D Monitoring Well(s) M of wells ❑Soil Boring(s) a of boring' ❑Geotechnical H of borings <br /> ❑Out-Of-Service Well ❑Out-Of-Service Well Renewal ❑Cross-Connection Repair <br /> ❑New Pump XYPump Replacement O Pump Repair <br /> WELL CONSTRUCnON <br /> Drilling Method ❑Mud Rotary ❑Air Rotary ❑Auger �,]Cable Too] ❑Push Point O Other <br /> Proposed Well Depth It Excavation in diameter ❑Open Bottom O Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched ❑Steel . D Plastic O Stainless Steel ❑Other <br /> Grout Seal Depth R ❑Neat Cement(941b bagl5-10 gal water) ❑Sand Cement sack mix 17 gal water <br /> ❑Bentonite(20%solids) ❑Manufacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted <br /> I <br /> Grout Placement Method CI Pumped D Free Fall ❑Other ❑Retardant/Accelerator(name) <br /> pEpES or rac <br /> on <br /> Pump er r <br /> By ed InstallB ❑Dill0 PContractor O Other <br /> I I <br /> ❑Concrete Pedestal Dimensions:Width R Length R Thick in D Christy Box ❑Stove Pipe Q <br /> 11 1$Submcrsiblc 0 Turbine ❑Other HP 1- Pump Set 170' _ft Standing Water Level 110 ft I <br /> i <br /> I' I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORT{ 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 T13E CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL C <br /> s WORKERS COMPENSATION LAWS. i <br /> f;. MIN M 2 I3 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS— <br /> F <br /> SIGNEA TITLE CEO DATE - <br /> E <br /> -Qt W <br /> w DEPARTMENT USE rONLY 4, <br /> 3 l EmployeelD4 ( 7C� <br /> Application Accepted By Date � _0 Area <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection B l Date 13❑ WAIVER Received <br /> Constructed Well <br /> Depth - ft <br /> COMMENTS 3'Ptll 7= "� <br /> PE SC Received heck# Amount Date Permit/ Invoice# Well IDN <br /> Codes Into B Cash Remitted Service Request fl <br /> O5IN 72 V!2 <br /> /� <br />