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WELL/PUMP PERMIT <br /> SAN JOAQVIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E WEBER AVE I"FL-STOCKTON CA 95M -(209)463-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECI"10M1S EXPIRES I YEAR FROM DATE ISSUED <br /> S y <br /> JOB ADORESS XX 31600 KOSTER RD` _ 4 _ i Crrvaip TRACY, CA I--/ �- > <br /> CROSS STREET HWYY 33/DURHAMFERRY_R}aPN 24PARCELSIZE S3 ��LAND USF.APPLICATION N p <br /> OWNER NAME NAT BACCHETTI PHONE 601-3768 <br /> OWNER ADORESC 6245 W. CALIFOBNIA _ C—ISTATTILIP TRACY,-CA 95304 <br /> CONTRACTOR HE14NINGS BROS. DRILLING CO., INC. PHONE 545-1185 <br /> CONTRACTOR ADDRESS 3525 PELANDALE AVE. CITY/STA-CE/ZIP MODESTO, CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CrTYISTATErLiP <br /> LICENSE 0(C-57 ❑C-6l 11D.09 ❑Other NUMBER 290813 EXPIRATION DATE 5-31-08 <br /> CWGRAPHICALINFORMATION: Coordinates X Y Town,hlp_ Rrnec Section_ <br /> INTENDED USF: V Domestic/Private ❑Irrigation/Agricultural ❑Industrial ❑WaterQuality Monitoring G Soil Sampling/Characteri226on <br /> 0Pub,icWater System _ <br /> If drn'crcm from Own aur yore N.— - n�.c7Nerrc. lio TN.� <br /> IYPEO -WORK EKNcw Well ❑Replacement Well Cl Well Alteration/Modification ❑Other <br /> ❑Monitoring Well(s)_ N of wells ❑Soil Borings) ,of bo..0 13 Gcoteehnical a ofbortrp <br /> ❑Out-Of-Scrvice Well ❑Out-Of-Service Well Renewal ❑Cross-Connection Repair <br /> ❑New Pump ❑Pump Replac.cmeni ❑Pump Repair <br /> W ELI.CONSTR I1Ci TION <br /> Drilling Method [Y`Nlud Rotary ❑Air Rotary ❑Auger ❑Cable Toul ❑Push point ❑Other <br /> Proposed Well Depth 180 —fl Excavation._ 12" —in diameter ❑Open Bottum ]Gravel Pack/Gravcl Siu___in diameter <br /> ❑Conductor Casing_ indiamater % Conductor(asjngDepth ____fl <br /> Well Casing Diameter 611 in Thickness/Gauge/ASTNI Sched�6K ❑Steel )dPlastic ❑Stainless Steel OOther_ <br /> Grout Sea] Depth_11)0 fl ❑Neat Cement(44 Ib bagl5-10gaf—ter) ❑Sand Cement_ suck mix/7 gal water <br /> J(Q kntomte(20%solids) ❑Rfanufacturcr Spcc%solids__% Name_ ❑Specs on File O Specs Submitted q <br /> Grout Placement Method k]Pumped ❑Fra Fall ❑Other ❑Retardant/Accelerator(name) C, <br /> PEDESTAL Installed By ❑Driller IX Pump Contractor ❑ Other (n <br /> ❑Concrete Pedestal Dimensions:Width 9 Length___It Thick in O Christy Box ❑Stove Pipe <br /> -pa. ❑Submersible ❑Turbine ❑Othet HP Pump Set_it Standing Water Level 11 p <br /> 1 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 RLLES AND REGULATIONS. 1 ALSO CERTIFY I HAT MY REQUIRED LICENSE IS <br /> ""ARL T'Nl1-& 1IV WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT'1 AM IN COMPLIANCE WITH ALL e <br /> WORKERS COMPENSATION LAWS ---- _ <br /> 1\ <br /> MINIMUM 24 HOUR ADVANC' I?EE REQUIRED FOR INSPECTIONS <br /> SIGNED SA Q�L.c�. r/rrrF SUPERVISOR DATE 9-26-07 <br /> 4YJ I I j I 1c4 LI <br /> 5 � <br /> z b 3 N R N E <br /> % !i <br /> VI` LI r" & <br /> - <br /> �µ DEPARTMENT USE ONLY <br /> Application Accepted Ry � _ Date l U /5 U Arca . __ E:mplcvec IDN <br /> Grout Inspex;tion B -"yG.: �� _ Date i-�- _ ❑ SPEC[AL Well Pt2rmat <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Constructed Well Depth It <br /> COMMENTS Cc e) ,,,i-u r <br /> PE SC Received Ch-k#/ Amount Date Permit/ laroke# Well ID# <br /> Code,, Info By Cash Remitted rvice Request N <br /> EHU-O-e]-We WF.I.L PUMP PERMIT <br /> I(17RW1 <br />