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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> __ to <br /> Joe ADDRESS 1805 Harbor St CITYZP Stockton i 95203 <br /> CROSS STREET Port Road 1 __ APN_ '"""- = _PARCEL SIZE 24.44 LAND USE APPLICATION# ib <br /> OWNER NAME Penny Ne•,urran G.'air. PHONE (209) 466-54464,1 <br /> {n <br /> OWNER ADDRESS 1205 Harbor St O�/Sx /Z/ate' 11YISTATE/LP_ Stockton / 95203 <br /> CONTRACTOR Geo-Ex Subsurface Exploration ! PHONE 916-799-8198 <br /> 1510 Madera Dr, I'xon, CA, 95620 <br /> CONTRACTOR ADDRESS CITY/STATEZP <br /> SUBCONTRACTOR LNGEO Inc. PHONE 709-664-7611 <br /> SUBCONTRACTOR ADDRESS 17278 Golden Va'_1e7 Parkway CITY/STATE/ZIP :,athroc r CA 9533L <br /> LICENSE X C-57 C-61 D-09 _ Other NUMBER 954267 EXPIRATION DATE r - 10 101,0 <br /> GEOGRAPHICAL INFORMATION: Coordinates Y Township_ Range Section <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial - Water Quality Monitoring K Soil Sam plingiCha racterization <br /> Public Water System _ . <br /> It different from Owner Wale,System Nime o aName or no N.mbe, <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Weil(s) #of wells ' Son Boring(5) eofb ngi, Geotechnical nor 6onngs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement - Pump Repair - Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary x Auger Cable Too] Push Point Other <br /> Proposed Well Depth 130 it Excavation 6 In diameter Open Bottom 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 Plastic Stainless Steel - Other —_- <br /> Grout Seal Depth 130 N x Neat Cement(94!b bag/5-10 gat 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 Onller _ Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length R Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set h Standing Water Level It <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 t AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> SIGNED 'o - TITLE Prcjec[ F.ngince: DATE 1::-31-1F <br /> iy'rc- A:T CH D I A <br /> 3 2018 <br /> VI UIN COUNTY <br /> NMrNTAL <br /> — pARTMRNT <br /> D PA 0 T M E N T US O LY <br /> I <br /> _ <br /> Application Accepted By / v _ �.Date l 1 0 Area_1 Employee IDx <br /> Grout Inspection By Date __.. PECIAL Well Permit <br /> Pump Inspection Byf., WAIVER Received <br /> Soil Boring Inspection By liG')'U� VO'L�� Date Cons[ruc ted Well Depth It <br /> COMMENTS -- <br /> PE SC Received Check#! Amount Permit/ <br /> Codes Info B Cash emitted Date Servic Re uest# Invoice it Well IDA <br /> 4 N,ELL IPU1.1P PERMIT <br /> a lJ, Illi/__llll•////�,I//,V_f. <br />