Laserfiche WebLink
T WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EAST MAIN STREET-STOCKTON CA 95202-(209)466-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS Chrisman Rd & Vernalis Rd CITY/ZIP Tracy 95377 g <br /> CROSS STREET_ _APN PARCEL SIZE LAND USE APPLICATION# <br /> OWNER NAMEI �/fes/VC,1�"yd�y�/(-Z> jC U-c h hi S C® `/ PHONE y <br /> OWNER ADDRESS •"•rr� �-+� T�V�Z CITY/STATE/ZIPLIcJ1 J yIO� <br /> r� 64 <br /> CONTRACTOR ABC L10Vln Drilling PHONE - 562-981-8575 <br /> CONTRACTOR ADDRESS 1180 E Burnett St CITYISTATE/ZIP Signal Hill, CA 90755 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP - <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 422904 EXPIRATION DATE 9/3 0/2 012 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System Geotechnical Instrumentation <br /> If different from Owner: 8F.r ys em ame n Name or one u or <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification X Other Inclinometer -T-Ext nsometers <br /> Monitoring Well(s) #of wells Soil Boring(s) III of tomes Geotechni 2 2 #of borings <br /> Out-0f-Service Well Out-Of-Service Well Renewal Cross-Connection Repai <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 7-35 ft Excavation 8 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth GS-TD ft Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mW7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall X Other Tremie Retardant/Accelerator(name) �T <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width It Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED 1,`-" TITLE President DATE 4/8/2011 <br /> LETTT <br /> ------------- <br /> l <br /> ------------------------ <br /> -11,Fr 11 <br /> u '«I <br /> #TT I I I L] <br /> ONV <br /> Application Accepted ByMDE!PARTMENT .USjDate Areae 7/ Employee ID# <br /> Grout Inspection By Date S,PEECIAALL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection/gay Date Constructed Well depth ft <br /> COMMENTSc4dy <br /> PE SC Received Check Amount!d Permit/ <br /> Codes Info B ash Remitted Date Service Request# Invoice# Well ID# <br /> S KTff 2 3 <br /> EHD 43-06 <br /> 8/04/08 WELL/PUMP PERMIT <br />