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A .LORI ken 5-h2h, 'rIXII.' //oo ,3!07 <br /> WELURUMP—PERMIT ( 0yryryry�j <br /> SAN JOADVIN COUNTY ENVIRONMENTAL HE AL Nim_ BBE' HAZELTON AVENUE-STOCKTON CA 95205- 20 +20 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> 26301 Tracy, CA 95307 <br /> JOB ADDRESS CIIY2P <br /> Hansen Road qy <br /> CROSS STREET Schulte Road APN 209-230-09 PautcFy SIZE 67 ac LAND USE APPLICATION#Agri cultural X <br /> OWNER NAME Sandeep Singh PHONE 209-513-0508 <br /> OWNERADORESS P O BOX 2509 C"/STATE/ZIP Ceres CA 95307 <br /> CONTRACTOR Nor-Cal Pump and Well Drilling PHONE 530-674-5861 <br /> CONTRACTORAoDRESS 1325 Barry Road C"STATE/ZIP Yuba City, CA 95993 <br /> SUBCONTRACTOR None PHONE <br /> SUBCONTRACTOR ADDRESS CRY/STATE/ZIP <br /> LICENSE XXC-57 9.1"1 D-09 I'Other NUMBER 908591 EIPUUTIONDATE 1/31/2018 <br /> GEOGRAPHICAL INFORMATION: Coordinates Y TOWMhlp_ Range_ Section_ <br /> INTENOEO USE DomesticPovate Rigatlon/AglicultumWr Industrial I:I Water Quality Monitoring I1$dl SamplinglCharactenzagon <br /> Public Water System <br /> IfdlSeren,lrom Oenec r nem .rw n eme or m u er <br /> TYPE OF WORN New WeIIXX i Replacement Well i I Well AltemtioNModificabon (Other <br /> Monitoring Well(s) Rofwells .I Soil Badng(s) pof WNNs I Geotechnical Rofwd's <br /> L Out-Of-Service Well a Out-Of-Service Well Renewal Cross-Connection Repair <br /> L New Pump L Pump Replacement a Pump Repair i Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary L Air rotary i Auger I Cable Tool i i Push Point I i Other Flooded Reverse Rotary <br /> Proposed Well Depth"'Ni 3 W Excavation 20' in diameter i Open Bottom Gravel Pack/Gmvel SizeTM m diameter <br /> Conductor.Casing indiameter / Conductor Casing Depth R <br /> Well Casing Diameter 12 1 Thickne Gauge/ASTM Sched '250 inche.S�Steel a Plastic Inless Steel liver <br /> 7 U Grout Seal Depth-� y Neal Cement(94 ft,bag 5-10 gel water) Sand Ce ant 10.3 sack sack m%x17 gal water <br /> DOW Benton1le 0%solid � Other <br /> �A Grout Placement Method L u Free Fall L Other a Retardant I Accelemtar <br /> S powsrI Installed By ❑Driller Pump Contractor ❑ Other <br /> Concrete Pedestal L Dimension:Width it Length it Thbk in ChristyBox a Stow Pipe <br /> Eymp - Submersible❑Turbine C Other ' HIP Pump Set R Standing Waterlevel It <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 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 /> M (MUM 24H UR ADV CE OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TITLE vice President DATE 2/15/2016 <br /> 4"r <br /> LU <br /> w, ti 0zs <br /> o 3go.w <br /> "Pilly Q¢� <br /> W <br /> ZQ z 1-41W <br /> N = <br /> t�DEPARTMENT SE ONLY <br /> Application Accepted By � to T, 'C '� Area O5 �( Employee IDR <br /> Grout Inspection By Dale ❑ SPECIAL WBII Permit <br /> Pump Inspection By Data ❑ WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth H <br /> COMMENTS t%/L6L <DAL Lo ( L W LL <br /> e . LinIf <br /> o =l!t� A Ll 5t� <br /> PE Sc "ByCash <br /> cldtl Amount Data PermlU InvolceR Well IDR <br /> Codas Ink Remltletl ServkaR ueatR6q ISD3 I - r13anon° 08 CG - 0l?7 *n b- Q° , W,4,Y Li. d 3a� s i>ca..'t 11'4'110 („i i <br /> /� <br />