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r <br /> 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 <br /> 26106 S.Patterson Pass Road CITY/ZIP Y�Trac CA <br /> Road R <br /> l <br /> Ni <br /> Via coo oaa <br /> CROSS STREET ViAPN PARCEL SIZE LAND USE APPLICATION# a <br /> In <br /> OWNER NAME Jet Mulch,Inc. PHONE w <br /> OWNER ADDRESS P.O.Box 1667 CITY/STATEIZIP Capitola,CA 95010 <br /> CONTRACTOR Krazan&Associates.Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATEZP Clovis,California 93612 <br /> SUBCONTRACTOR Kra2an&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis.Califomia 93612 <br /> LICENSE VC-57 I C-61 f-,D-09 ❑Other NUMBER 499906 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING:11 General Mineral/Coliform Bacteria(4391)11 Dibromochloropropane(4392) I Arsenic(4393) <br /> INTENDED USE 1-1 Domestic/Private ❑Irrigation/Agricultural ❑Industrial H Water Quality Monitoring i I Soil Sampling/Characterization <br /> I I Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 1 i New Well 1':Replacement Well L I Well Alteration/Modification i Other <br /> I.Monitoring Well(s) #of wells a Soil Boring(s) #of borings Geotechnical 5 #of borings <br /> Out-Of-Service Well I Out-Of-Service Well Renewal I Cross-Connection Repair (10-25 Feet) <br /> i New Pum _Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method .l Mud Rotary a Air Rotary /Auger C Cable Tool Push Point Other <br /> Proposed Well Depth )0—;y 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 i Steel Plastic Stainless Steel '._Other <br /> Grout Seal Depth 10'R S� ft y Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack marl'gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped --.Free Fall IOther Retardant/Accelerator(name) <br /> PEDESTAL Installed By -11 Driller Pump Contractor Other <br /> Concrete Pedestal-:Dimensions:Width ft Length ft Thick in i Christy Box Stove Pipe <br /> PUMP I Submersible I Turbine -i 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 /> MIN UM 48 HOD NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 04/09/2020 <br /> F�MFNr <br /> EI AFD <br /> R 152 <br /> 020 <br /> QUI OU <br /> EPARrME rY <br /> NT <br /> DEPARTMENT USE ONLY n <br /> Application Accepted By Date y �S Z ct5 Area C Employee ID# i]4 <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By qq ��(� L Date WAIVER Received <br /> Soil Boring Inspection By �f �S 'A Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received hec AmountDate Permit/ Invoice# Well ID# <br /> Codes Info Remitted Service Re uest# <br /> 37.7 lS-O 31061 <br /> EHD 43-06 revised 4114118 WELL/PUMP PERMIT <br />