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} <br /> WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY ENvoumuENTAL HEALTH DEPT 515624 1868 East HazeHon Avenue-STOCKTON CA 95205.8232-(209)468-3420 <br /> NON-REFUNDABLE PERM CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDREs9 14629 Wildwnod Road Cm2w Stockton 95215 <br /> CROSSSTREET Jack Tone Road APN 203-030-02 PARCELSIZE TX'o LANDUSEAPPLICATION# <br /> OWNER NAME Rob Norman PHONE 479-4661 <br /> OWNER ADDREss 13801 Wildwood Road CITYISTATERIP SrnArTnn- CA 95715 <br /> CONTRACTOR Delta PttmD PHONE 209-466-9625 <br /> CONTRACtaRADOREsa 646 S. California Street CRYISTATEIZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTORADDRESS Cm/STATE/ZIP <br /> LICENSE C G57 x C-51 0 D-09 0 Other NUMBER 724778 EXPIRATION DATE D8/14 <br /> GEOORA HlcA,WFORMATIOC: CoordI a X Y Townahlp_ Range_ Section_ <br /> INTENOPA USE D DomrNdddPnvste,' I tion/Agnwiturai ❑Industrial O Water Quality Monituring O Sol Sampling/Charactenm8on <br /> 0 Public Water S <br /> N�krenitron lice N. er <br /> TYPE OF WORK O Now Well 0 Replacement Well D Well AlleraflONModif cation 0 Other <br /> 0 Monitorin Wells #of wells ❑Soil Boring(s) #.b..'. D Geotechnicalx or wr, <br /> D Out-Of-SerWw Well t-CfSmIce Well Renewal ❑Crosa-ConneNon Repair <br /> 0 New Pump O Pump R9 lacomen -erp Repair 0 Raise WBII Cavin <br /> WELL CONBTRUCYIDN <br /> Drilling Method 0 Mud Rotary 0 AR Rotary 0 Auger 0 Cable Tool 0 Push Point ❑ Other <br /> Proposed Well Depth_n Excavation in diameter 0 Open Bollom 0 Gravel Pack/Gravel Sae In diameter <br /> C Conductor Casmg In diameter / Conductor Casing Depth it <br /> Well Casing Diameter_in Thickress/Gauge/ASTM Schad 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br /> Grout Seat Depth ft 0 Neat Cement(94 1b bag'5-10 gal water) 0 Sand Cement seek MIDT gal water <br /> 0 Bentonite(20%solids) 0 Other <br /> Grout Placement Merced 0 Pumped 0 Free Fan O Other 0 Retardant/Accelerator(nems) _ <br /> YAt Inatelled try 0 Driller ❑Pump Contractor 13 Other <br /> O Concrete Petl tel Dimsnelons:Width_fl Length ftThick in 0Christy Sox ❑Stove Pipe <br /> ❑Submersi la umina 0 Other HP Pump Set 13 ft StandingWater Level <br /> I HEREBY CERTIFY THA 1 AVE 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 VVITH THE CALIFORNIA CONTRACTORS STATE LICENSE DOARD AND TtIAT 1 AM IN COMPLIANC: WITF< ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> IIIGNeD ��- -14E7� Tore CFO DATE 10/24/13 <br /> I Ilk <br /> HE <br /> HDP R <br /> DEPARTMENT <br /> r. USE ONLY - - --" -- <br /> ApplcmoAcceptedBy t,.. Data tO Areae Employee l0#�k-Sri. IeS <br /> Grout Inspection By Data SPECIAL WGII POITTIt <br /> Pump In orgy �11/d� Date WAIVER RGCelved <br /> Sol Constructed Weil Depth N <br /> COMME (/ <br /> PE SC Received Ch"IUY Amount Data PBnnIU Invoice Is Well ID# <br /> Codes Mb By Remitted Service Request# <br /> ENO.aaB YIBLRUMP PSRMn <br />