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R <br /> V <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1679 Lower Sacramento Road CITY/ZIP Lodi/95242 <br /> m <br /> CROSS STREET E. Olive Ave. APN 05803029 PARCEL SIZE 2.43 A p <br /> LAND USE APPLICATION# p <br /> A <br /> OWNER NAME BDC Lodi III LP c/o Bowman Development Company, Inc. PHONE -- y <br /> OWNER ADDRESS 1556 Parkside Drive CITY/STATE/LP-Walnut Creek/CA /94596 <br /> CONTRACTOR Salem Engineering Group, Inc. PHONE 559-271-9700 <br /> CONTRACTOR ADDRESS 4729 W.Jacquelyn Avenue CITY/STATE/ZIP Fresno/CA/93722 <br /> SUBCONTRACTOR Salem Engineering Group, Inc. PHONE 559-271-9700 <br /> SUBCONTRACTOR ADDRESS 4729 W.Jacquelyn Avenue CITY/STATE/ZIP Fresno/CA/93722 <br /> LICENSE VC-57 C-61 D-09 _I Othef NUMBER 970772 EXPIRATION DATE 3/31/2020 <br /> DOMESTIC WELL SAMPLING:D General Mineral/Coliform Bacteria(4391)C Dibromochloropropane(4392)❑Arsenic(4393) <br /> INTENDED USE Domestic/Private -1 Irrigation/Agricultural ❑Industrial L Water Quality Monitoring L Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well i Well Alteration/Modification i Other <br /> Monitoring Well(s) #of wells VSoil Boring(s) 6 #of borings I Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Ll Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair i I Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Ro ary i AT Rotary VAuger i Cable Tool F Push Point n Other <br /> Proposed Well Depthil;b ft Excavation in diameter 11 Open Bottom L Gravel Pack/Gravel Size in diameter <br /> _1 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in I Thickness/Gauge/ASTM Sched Li Steel Ll Plastic G Stainless Steel L Other <br /> Grout Seal Depth r�-_� It VNe.t Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) t i Other <br /> Grout Placement Method i'i Pumped i I Free Fall ✓,Other Tremle Pipe Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller , Pump Contractor I Other <br /> Concrete Pedestal LDimensions:Width ft Length It Thick in i Christy Box C Stove Pipe <br /> PUMP - Submersible. Turbine F Other HP Pump Set ft Standing Water Level ft <br /> I 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 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED 6ham kekh TITLE Geotechnical Project Engineer DATE 10/10/2019 <br /> C1 VA <br /> ?? 20, <br /> F VAN�0 <br /> _PTA(N�f� <br /> 9RTjyFHT <br /> ------------------------ <br /> H. <br /> �A M E N T U E O L Y ���{i,�l�.,(� ►J/�����J�.. <br /> Application Accepted By ate �7 1 Area `Z/ Employee ID#4 <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date pp 1-1 WAIVER Received <br /> Soil Boring Inspection By Date I I Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Che Amount Date Permit/ <br /> Codes Info B Cash Remitted Service Request# Invoice# Well ID# <br /> I G19 <br /> END 43-06 rey,sed 4114118 <br /> WELL/PUMP PERMIT <br />