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SAN JOAgU1NC0UNTYENVIRONMENTAL HEALTH DEPT WELL/PUMP PERMIT <br /> 1868 East Hazelton Avenue-STOCKTON CA 96205.6232-(209)463 <br /> NONREFUNDABLE PERMIT CALL(209)953.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSU <br /> JOB AooREasJ. <br /> ?751., F. - um_ OF CITY/ZIP I!NDEN CA 95236 <br /> CROSS STREET_ iS Qu>.TTFY__ABe APN 067-24-003 PARCEL SIZE 2 <br /> 'AND USE APPLICATION# <br /> OWNER NAME .EUGENE CAFEGGF <br /> PHONE 209-481_5g5Fi <br /> OWNERADDRESS _5_475 VAN AT.7 EN Rn CITY/STATEIZIP_j mrPnCKmr1TT r'➢ <br /> �L4.21-5 <br /> CONTRACTOR —delta Pumv_GmnrTCmny TDMTTrTnt:, f1i,r.:O-, WORKS ffttti3&1_`209=466-96?_ <br /> CONTRACTOR ADDRESS 646 S. California Street cl7Y/srnrE/zIP _Stockton, CA 95203 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE 110-57 X C-61 0 D•09 ❑Other NUMBER 724778 -EXPIRATION DATE 08A L, <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section <br /> INTENDED USE 0 Domestic/Private EXIXIgatlon/Agrlcuitural 0 Industrial ❑Water Quality Monitoring 0 Soll Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner; We r ye-m amo on ac ame or none um er <br /> TYPE OP WORK 0 New Well ❑Replacement Well 0 Well Alteration/Modlficatlon 0 Other <br /> 0 Monitoring Well(a) #Of wells D Sol]Boring(s) 0 of bodnps p Geotechnical 9 of borings <br /> 0 Out-OfWell ❑Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> 0 New Pum 0 Pump Replacement X)eump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION .. <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger ❑Cable Tool 0 Push Point ❑ Other <br /> Proposed Wall Depth ft Excavation In diameter 0 Open Bottom ❑Gravel Pack/Gravel Size In dlamE <br /> 0 Conductor Casing In diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_In Thickness/Gauge/ASTM Schad 0 Steel 0 Plastic 0 Stainless Steel ❑Other <br /> Grout Seal Depth ft 0 Neat Cement(94 lb bag/5.10 gat water) ❑Sand Cement sack m1x17 gal wE <br /> 0 Bentonite(20%solids) D Other <br /> Grout Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedeata)Dimensions:Width It Length ft Thick In ❑Christy BOX Cl Stove Pip. <br /> PUMP Cp( bmerslble0 Turbine 0 Other. HP 60 Pump Seta - N'ft Standing Water Level I L tS <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SF <br /> JOAQUIN COUNTY'ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT J AM IN COMPLIANCE WITH Al <br /> WORKERS COMPENSATIO LAWS; <br /> UM 24 OUR ADV.ANCE'NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED_ TITLE CEOR I (e, <br /> DATE <br /> PUMPIWELL is located ,t ' <br /> NOTE:Take wGMWAy 26 r ] <br /> approa.323.62 n.from dirt <br /> EASTpest the town of UNOEN,at rd �til <br /> Escalon adlata Rd.cominue east •,f <br /> on hlehway 26 forabout 3.5 mees I s <br /> to a wkWmlll on the North side of <br /> the hl{hwry, j4 { , <br /> I t - 4 2i, <br /> I Ni 1 <br /> LE IL u <br /> I L r , �t vl•E. <br /> 19, <br /> A F WINDMILL t y <br /> DEPARTh1ENT USE ONLY <br /> Application Accepted By � � Date� _ Area LA`ZV Employee IDIb Ct��t� <br /> Groyt inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER RecelVed <br /> Soil Boringlnspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received a #! Amount Permit/ <br /> Codes. Info B s Remitted Date Service Re u.stft Inv <br /> olco# WeI11D# <br /> A 1 0s' _�-1� 5,00075 33 <br /> EHD 43.08 <br /> 6104/08 wnI I sonnno oco,...r <br />