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0 • <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN 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 /> rA <br /> JOB ADDRESS 25460 South Schulte Road CITYIZIP Tracy,CA 95377-9709 m <br /> D <br /> 0 <br /> CROSS STREET Mountain House Parkway APN 209.440-35 PARCEL SIZE 2 acres LAND USE APPLICATION#NA F <br /> m <br /> H <br /> OWNER NAME Jacab Corporation PHONE <br /> OWNER ADDRESS 25460 South Schulte Road CITYISTATEIZIP Tracy,CA 95377 <br /> CONTRACTOR Gregg Drilling PHONE (925)313-5800 <br /> CONTRACTOR ADDRESS 9.50 Howe Road CITYISTATEIZIP Martinez,CA 94553 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE JC-57 C-61 D-09 Other NUMBER 465165 EXPIRATION DATE 1/31/18 <br /> GEOGRAPHICAL INFORMATION: Coordinates X 37.72295 y-121.53198 Township 2S Range 4E Section 28 <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 New Well Replacement Well LWell Alteration/Modification Other <br /> Monitoring Well(s) #of wells -/Soil Boring(s) 12 If of borings Geof .hnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-r- 'epair <br /> New Pump Pump Replacement Pump Repair <br /> WELL CONSTRUCTION G <br /> Drilling Method Mud Rotary Air Rotary Auger Cabl-` + (i <br /> Proposed Well Depth 20 ft Excavation 2 G` ICC (r l�Y. avel Size in diameter <br /> Conductor Casinn 1 r <br /> Well Casino- "'-�-- A� ( P y� N f l; -4 el Other <br /> J rr I rJ`/ sack mix17 gal water <br /> /� r� `y1 (,4 CA r � f hQ f ; Box Stove Pipe <br /> G ` <br /> / C r. <br /> C / ) J r it �V er Level ft <br /> NS RDANCE WITH SAN <br /> ` 1UIRED LICENSE IS <br /> Y)1X ^ ( C 1 LANCE WITH ALL <br /> 1 t 1 <br /> It 1 53-7697 <br /> Si AllJL 'Y^Vn\ C �C _ DATE 7/26/17 <br /> 1 1 t <br /> ( 6 , G6q . s � �"y <br /> 11 IZ111.7 <br /> PFJ <br /> A <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# Prh M <br /> Grout Inspection By Date ❑ S ECTAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date arm Invoice,Invoice# Well ID# <br /> Codes Info By Cash Remitted Service Request# <br /> '13i'� ISO 7f1n � U") <br /> EHD 43-06 WELL(PUMP PERMIT <br /> 4130112 <br />