Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAOUIN 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 Central Parkway at Mustang Way S y Comfy ecITYZP Mountain House,CA m <br /> CROSS STREET APN5r"+ Cij .V / PARCEL SIZE L,2 LAND USE APPLICATION# p <br /> m <br /> OWNER NAME CATX Partners LLC PHONE 408-666-3743 y <br /> OWNER ADDRESS 5875 Assist Ct CITY/STATE/ZIP San Jose,CA 95138 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis.California 93612 <br /> LICENSE VC-57 C-61 D-09 Other NUMBER 499908 EXPIRATION DATE 10,131/2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK i!New Well I Replacement Well 1 Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells _I Soil Boring(s) _ #of borings Geotechnical 8 #of borings <br /> i Out-Of-Service Well I Out-Of-Service Well Renewal Cross-Connection Repair (10-50 Feet) <br /> New Pump Pump Replacement i Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary /Auger Cable Tool Push Point Other <br /> Proposed Well Depth 10 -�0 ft Excavation 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 ;n -S D ft f Neat Cement(94 lb bag/5-10 gat water) Sand Cement sack man gal water <br /> -Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By i Driller Pump Contractor Other <br /> J Concrete Pedestal Dimensions:Width ft Length It Thick in Christy Box .Stove Pipe <br /> PUMP Submersible I 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 48 HOU VA E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 03/31/2020 <br /> Fi!Icz <br /> jV�O <br /> PR D20 <br /> RO �NqiCpV <br /> OER <br /> At <br /> /J DEPARTMENT USE ONLY <br /> Application Accepted By �-1 Date Z"�'' Area � / � Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date 1 i Constructed Well Depth ft <br /> COMMENTS <br /> I42 <br /> Sc Received Check# Amount Date Permit/ Invoice# Well ID# <br /> Info Remitted a ice Re uest# <br /> 50 Z&L15.?O <br /> EH0 43-06 revised 4114/18 WELL/PUMP PERMIT <br />