Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 EASTHAZELToN AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joe ADDRESS 1315 W Swain Rd,Stockton pined lMrord efthl•propend adds*eeemape below) CrryrzpCA 95207 <br /> CROSSSTREET MllchlerAve APN 097-290-16 PARCEL SIZE 0, Zh LAND USE APPLICATIONS p <br /> OWNER NANE City of Slocidon PHONE <br /> OWNER ADDRESS City Hal,425 N.B Dorado St. CITYISTATEMP StoW--CA 95202 <br /> CONTRACTOR Underground Construction CO. PHONE 707-741-1761 <br /> CONTRACTOR ADDRESS 5145 Industrial Way CrrYISTATEfdP Benicia.CA 94510 <br /> SUBCONTRACTOR Conpro Companies lnc. PHONE 510'509499 J <br /> SUBCONTRACTOR ADDRESS 2625c Barrington Court Crtv/STATE/LP Hayward,CA 94545 { <br /> / 1 ` <br /> LICENSE VC-57 D C-61 0 D-09 Olhef NUMBER 791878 EXPIRATION DATE <br /> I <br /> DOMESTIC WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)0 Dibromochloropropene(4392)0 Arsenic(4393) <br /> INTENDED USE 0 DOmestiCIPriVale D Inlgalon/AglicWtural 0 indusWW 0 Water Quality Monitoring 0 SNI Sampling/Characterization <br /> 0 Public Water System <br /> IIdaerenl from Owner: Water SyMem Nam Contact Name or Phone Number <br /> TYPE OF WORK D New Wel 0 Replacement Weil 0 Well Allerallon/Modi5callon ID Other Cathodic Protection <br /> 0 Monitoring Wel(s) tl of wells 0 Soll Soring(s) *of b"d"ae 0 Geotechnical A or bod"Qe <br /> 0 Out-0f-Service Wel D Out-Of-Service Well Renewal 0 Cross-Connectlon Repair <br /> D New Pum D Pum Replacement D Pum Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VMud Rolary 0 Alr Rotary 0 Auger 0 Cable Tool D Push Point 0 Other <br /> Proposed Well Depth 200 R Excavation 6" In diameter 0 Open Bottom VGravel PackJGravel Size In diameter <br /> 0 Conductor Casing no cost In diameter / Conductor Casing Depth ft <br /> Well Casing Dlameler_In Thickness/Gauge/ASTM Sched0 Steel 0 Plasle 0 Stainless Steel 0 Ocher <br /> Grout Seal Depth C 1p R � Neat Cement(94/b bag/5-10gal wafer) 0 Sand Cement sack m&f7 gal water <br /> .Bentonite(20%sods) 0 Other <br /> Grout Placement Method 0 Pumped 0 Free Fal 0 Other 0 Retardant/Accelerator(name) i <br /> E T Installed By ❑Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedestal DDIrl*mtIons:Wldlh R Length ft Thlck In 0 Christy Box 0 Stove Ptpe <br /> PUMP D Submersible Turbine 0 Other HP Pump Set R Standing Water Level R <br /> I HEREBY CERTIFY THAT 1 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS i <br /> CURRENT,0ND ACTIVE WITH;rHE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS \MR\ENSATION LJyWS. <br /> MINI O 8 HOUft ADVANCE NOTICE REQUIRED FOR INSPECTIONS•PLEASE CALL(209) 7 9t <br /> SIGNED TrrLES 1`J\ DATE <br /> i <br /> 8-2 ul <br /> i <br /> .1 <br /> r <br /> �E <br /> ALTH <br /> S�NV\R�� <br /> N�IINA D PARTMENT USE ONLY <br /> Application Accepted By Date ^ GI W Area Empbyee ID3 c?�(`'1 <br /> Grout Inspection By V to bbl"-f-Ici ❑ SPECIAL Well Permit <br /> Pump Inspection By Date 0 WAIVER Received <br /> Soil Boring Inspection By C,1 C\ Constructed Well Depth R <br /> COMMENTS <br /> ICC <br /> PE Sc Received Check I Amount Date Permit/ invoice/ Well IDN <br /> Inffooi Cash Remitted Service R uedct f <br /> EHo esae reNeed urate <br /> W <br /> qa2 f <br /> /J FIL.PUMP PERMn <br /> Ag,Do 2, <br />