Laserfiche WebLink
WELUPUMP PERMIT <br /> SAN JOAQUIN CouNTYENvinommENTALHEALTH DEPARTMENT 1868 EAST HAZELTOM AVENUE-STOCKTON CA 95205£232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 4343 N Wilson Way Sltxklon/95205 <br /> CiTr2ir m <br /> CROSS STREET I:.McAllen Road APN 132-02-022 4.55 actes <br /> PARCEL SIZED <br /> AND USE APPLICATION M o <br /> OWNER NAME Illyden L.P.,a California Limited Partnership PHONE 559-269-5155 <br /> OYwER ADDRESS 2637 W.Lake Van Ness Circle CITYISTATEMP I•resno/CA/93711 <br /> CONTRACTOR Salem Iingincering Group,Inc. PHONE 559-271-9700 <br /> CONTRACTOR ADDRESS 4729 W.J.Xquclyn Avenue GTyISTA,,0, I:resno/(.A/93722 <br /> SUSCONTRAC TORICONSULTANr Salem Engineering Group,Inc. pw,,559-271-9700 -- <br /> SUSCONTRACTORICONSULTANTADMEEE 4729 W Jacquelyn Avenue CITy/STATErEw I:resno/(.A/93722 <br /> LICENSE /C 57 LI C-81 II D-09 11 Other NUMBER 970772 ExPIRATIONDATa 03/31/2020 <br /> &LUNG PARTY. D OywER 11 CONTRACTOR SURCONTRACTOM/CONSULTANT <br /> DOMESTIC WELL SAMPuNia:I.General Mineral/Coldorm Bacteria(4391)I Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private 1 Irrigation/Agricultural ;I Industrial 11 Water Quality Monitoring vl Sod Sampling/Characterization <br /> Public Water System_ _ <br /> If 1.17-1011—Owre WA—Sy-4—Name Cmtad Name m Phone Number <br /> TYPE OF WORK New Well I Replacement Well 11 Well ARerabon/Modlhcallon Other <br /> Monitoring Well(s)_ M of walla 11 Sod Boring(S) _ M°f b.." v�Geotechnical 9 <br /> Out-OfService Well -1 Out-Of-Semce Well Renewal Cross Connection Repair ^ <br /> New Pump Pump Replacement I I Pump Repair Raise Well Casing (+A YAf` <br /> WELL CONSTRUCTION ecwIr� Nr <br /> Drilling Method �Mud Rotary Air Rotary y Auger 11 Cable Tool I Push Point i 1 Other `ft6 <br /> Proposed Well Depth It Eacavatcin__in diameter N Open Bottom LI Gravel Pack/Gravel Size in d�ameer <br /> Conductor Casing in diameter I Conductor Casing Depth_ ft G 02 <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Schell I'Steel I I Plastic I I Stainless Steel ;.Other O'� <br /> Grout Seal Depth_ft ./Neat Cement(94 lb beg)5-10ga)wafer) I I Sand Cement_ sack-R gal w AQV/N <br /> co <br /> Bentonite(20%soldS) -Other Rlo)v f� IiAtrr <br /> Grout Placement Method Pumped if Free Fall Vr Other IPC 111iC 1;Retardant/Accelerator(name) �-Pd IV rd <br /> PEDESTAL Installed By 1 Driller Pump Contractor Other <br /> Concrete Pedestal (Dimensions Width ft Length It Thick in Christy Box I Stove Pipe <br /> PUMP _ Submeryblel i Turbine Other_ — HP Pump Set _it Standing Water Level__ _--It <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 /> MI �M48 HOUR ADVANCE NOTICE RLGt'JIRIL I JR ITJ.;'F,-il_i; P,- Ac;L „ALL_ (2031953-7G97 <br /> t <br /> SIGNED TITLE 'n. I aeC�' DATE <br /> 4- _T <br /> --]I. T <br /> 4�—4� <br /> D E P A R T M E N T U E0 L Y <br /> Application Accepted By Date f Area mployee IDM <br /> Grout Inspection By 11 SPECIAL. ) Date I Well Pefm It <br /> Pump Inspection By Date - 11 WAIVER Received <br /> Sod Boring Inspection By Date Constructed Well Depth 1t <br /> COMMENTS <br /> PE SC Received eC Amount Dat Permit] Invoice M Well IOM <br /> Codes Info B Rem Service Request M <br /> 1 <br /> EHD4306 &118019 WELLl UMPPERMIT <br />