Laserfiche WebLink
r..r �.,✓ <br /> WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EAST MAIN STREET-STOCKTON CA 96202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(205)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADD Ess Eight Mile Road and Tinion Pacific RR CITYIZIP Stockton,CA <br /> D <br /> Lower Sacramento Rd ° <br /> CROSS STREET APN PARCEL SIZE LAND USE APPLICATION# I� <br /> OWNER NAME City Of Stockton PHONE 209-937-8212 y <br /> OWNERADDREss 425 N. E1 Dorado StreetCITY/STATE/ZIP Stockton, CA 95202 y <br /> CONTRACTOR Blackburn Consulting PHONE 209-522-6273 <br /> CONTRACTOR ADDRESS 4622 Glass Court, Suite A CITY/STATEIZIP Modesto, CA. 95356 <br /> SUBCONTRACTOR V & W Drilling, Inc. PHONE 209-369-9600 <br /> SUBCONTRACTOR ADDRESS P.O. BOX 970 C'''I)TYISTATE/ZIP Lodi., CA 95241 <br /> LICENSE X C-57 '.C-61 D-09 Other NUMBER% 66 1 EXPIRATIONDATE -�i7�t9V <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private Irrigation/Agricultural [Industrial _I Water ouallty Monitoring 5 Soil Sampling/Characlerizatior <br /> .i Public Water System <br /> It difleren;from Owner: W.t—pa em ame G.nt.,t N.,ne or one um er <br /> TYPE OF WORK 7 New Well Replacement Well Well Alteration/Modification .-Other <br /> Monitoring Well(s) #of wells ;_Soil Boring(s) n er bodnp Geotechnical�. 9 9 or horinns N <br /> ; i <br /> Out-Of-Service Well =Out-Of-Service Well Renewal ;_:Cross-Connection Repair <br /> New Pump I Pump Replacement. "'Pump Re air <br /> WELL CONSTRUCTION <br /> Drilling Method �,Mud Rotary Air Rotary r,Auger 0 Cable Tool a Push Point Olfler <br /> Proposed Well 2 Borings to 70' 1 Borings to 35' �BDr3:1�S <br /> 11 Borings to 20' 1 Borings to 10' 2_Barings LD 5' 1 <br /> Well Casing <br /> Grout Seal Depth 70 ft ti Neat Cemen((941b bag/5-10 gal water) C,Sand Cement sack mixl7 gal water <br /> Bentonit (20%solids) ':r Other <br /> Grout Placement Metho Pumped Li Free Fall T Other Tremmie _Retardant i ACcelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> .i <br /> Concrete Pedestal Dimensions:Witlth H Length ft Thick in a Christy Box Cl Stove Pipe <br /> PUrdP :7 Submersible i';Turbine _ Other HP Pump Set ft Standing Water Level R (� <br /> I HEREBY CERTIFY THAT! 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 /> ,� <br /> f � �/P•Jy/} L...•rPitrr,. 24 Ht7i,1 : DVANCE NOTICE REQUIRED FOR INSPECTION$ <br /> IG <br /> SNED IZ- � J 7C1 itlLJL%Yr DATE -1 p <br /> TITLE 1" Yt'>1C�/-�T' L::.f 3 . 1 0 . 0 O <br /> tt c e <br /> t T USE ONLY <br /> Application Accepted By Date c3 3 Area <br /> Employee ID# <br /> Grout Inspection By Dale SPECIAL Well Permit 6 <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date <br /> COMMENTS Constructed Well Depth ft <br /> PE Sc Received Check#/ Amount Permit/ <br /> Info B Cash Remitted Date Service Re uest# invoice# Well ID# <br /> 3 <br /> EMD 49.05 <br /> 9 2Co1 <br /> WELL-FUM?PERMrt <br />