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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> U1 <br /> JOB ADDRESS 228 N.Hunter Street CITyrzIp Stockton/95202 <br /> �i D <br /> CROSS STREET East Miner Avenue APN 139-13-0216 PARCEL SIZE -I aC. LAND USE APPLICATION# z <br /> OWNER NAME Visionary Home Builder;,CA elba VCOR LP-Contact:Justin Llata PHONE 209.466.6811 y <br /> OWNER ADDRESS 315 N.San Joaquin Street CITY/STATEIAP Stockton,CA 95202 <br /> CONTRACTOR V&W Drilling-Contact: Karli Stroing PHONE 209.981.7755 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITYISTATEIZiP Galt,CA 95632 <br /> SUBCONTRACTO CONSULTANT Condor Earth-Contact:Ron Skaggs,Principal Engineer PHONE 209.532.0361,Ext.2211 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 188 Frank West Circle,Suite I CITYISTATE/ZIP Stockton,CA 95206 <br /> LICENSE X C-57 L.C-61 1 D-09 i Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> BILLING PARTY: �]OWNER I CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)7 Arsenic(4393) <br /> INTENDED U - Domestir/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 Well Alteration/Modification Other <br /> - Monitoring Well(s) #of wells Soil Bodng(s) #of borings X Geotechnical l #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump El Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary i 1 Air Rotary X Auger ❑Cable Tool ❑Push Point I i Other <br /> Proposed Well Depth 30 to 50 ft Excavation 4 1/2 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 Schad D.Steel ❑Plastic 1 Stainless Steel Ti Other <br /> Grout Seal Depth full depth ft X Neat Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mix/7 gal water <br /> ❑Bentonite(20%solids) C'Other <br /> Grout Placement Method Pumped 7 Free Fall X Other Trernie -Retardant/Accelerator(name) <br /> PEDESTAL Installed By -.Driller Pump Contractor - Other <br /> -Concrete Pedestal Dimensions:Width ft Length ft Thick in -J Christy Box _Stove Pipe <br /> PUMP -Submersible 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 /> MINIM OUR E OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Project Coordinator DATE 04/28/2020 <br /> If <br /> RE yMFN <br /> C�c�VE6 <br /> o R ?9 ?0?0 <br /> lRO N <br /> 0Ep&76q R TMENTY <br /> DEPARTMENT USE ONLY L <br /> Application Accepted By Date -141211 ZOl O Area $���<�n Employee ID# J 1� <br /> Grout Inspection By Date 11 SPECIAL Well Permit <br /> Pump Inspection By Date 1! WAIVER Received <br /> Soil Boring Inspection By Date 57A13 Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info By_ Cash Remitted Service Re uest# <br /> 37, Asa �� 56 A•Z l'1 <br /> EHD 43-06 6/1112619 IaB��S�oB WELL/PUMP PERMIT <br />