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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joa ADDRESS 30636 E. CARTER RD. cmYmp FARMINGTON, 95230 <br /> CROSS STREET S. HENRY RD. APN_ 21%1-c, L�- PARCEL SIZE��UND USE APPLICATION% <br /> OWNER NAME JENKINS POULTRY PHONE 886.1000 C <br /> DINNER ADMEN 309636 E. CARTER RD. oTY/STATE21P FARMINGTON, CA.95230 <br /> CONmRAcTM N &S IRRIGATION INC PHoa 209.599.3456 <br /> commCTORADDREss 215 W MAIN STREET crtvrsTATEZP RIPON. CA, 95366 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CDYISTATE/ZIP <br /> LICENSE C-57 CA1 D-09 Xother C10 NUMBER 662732 EI14RaM NDATE D1/31/17 <br /> GEOORAPHICALINFORNAT : COofdinaMX Y TOWnehlp_ Range_ Section_ <br /> INTENDED USE Domes(I PrivaW _'InigatioNAgricultural �Industrial Ll Water Quality Monitoring ::Soil Sampling/Chareder¢Mion <br /> IPI®Huish rOer yvnr�eemr a• mF mN.bef <br /> r yF em o amsa <br /> TYPE OF WORK New Wail Replacement Weil Well AlteratiOWMorificatlan Other <br /> MoMtoring Wail($)_k of" Its Sal Bonng(s) "Dr"o"ps Geotechincal "mlp,iy9 <br /> Out-06Service Well Out-Of-Senice Well Renewal Cross-Connection Repair <br /> New Pump x Pump Replacement Pump Repair Raise Well Casing <br /> WELLCONSTRUCTION <br /> Drilling Method Mud Rotary Ah Rotary - Auger Cable Tool Push Point -- Ocher <br /> Proposed Well DepN ft Excavation in diameter Open Bottom GrI PaWGrwel Size in diameter <br /> Conductor Casng in diameter / Conductor Casing Depth R <br /> Well Casing Diameter_in ThicknesWGauge/ASTM Sdmd Steel Plastic Stainless Steel Other <br /> Grout Seal Depth ft Neal Cement(94It,oag/5-10 gal water Sand Cement sack mix0 gal water <br /> Berronite(20%Solids) Ober <br /> Grout Placement Method :.Pumped .. Free Fell Other Retardant/Accelerator(mamas) <br /> PEDESTAL Inshlletl By Drier Pump Convector Other <br /> Concrote Pedestal DMenabns:Wrth_ft Lengh ftTNck In - Christy Box Stove Plpe <br /> uMP XSudnersible:. Turbine Other MP Pump B R StandYg Water Level 142 R <br /> I HEREBY CERTIFY THAT I RAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIM M: UR ADVANCE NOTICE "QUIRED FOR WECTIONS•PLEASE CALL(209)953.7697 <br /> Slon6o nnE u � DATE '�- <br /> N <br /> RNryAll <br /> EN�r <br /> Yp <br /> OQZ��J <br /> OE PAR T ME NT SE NLY ����. 'I�; ,/ � C <br /> Application Accepted By Data Z Mea VVI Employee ID"T. -Co^•e' <br /> Grout Inspection By Is SPECIAL WBII Perrnit <br /> Pump Inspe9yon By Dale _ WAIVER Received <br /> Soil Boring In nBy ' Date Constructed!Well Depth R <br /> COMMENTS 4JLNrA <br /> PE SC Reeshwd at Amount Wb ParmlV Invaiu• Wall ONCedes Info I Byash Remkbd ServrceRequest M <br /> 5431 o)� 2.2 ?1J S3� S SPO ZZ <br /> EHD A$N WELLMUW PERMn <br /> x 2 <br />