Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT E,,AAIL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS 223 S Austin Roadftl/ CITY/ZIP Ripon,CA <br /> A <br /> CROSS STREET ' g(120fJ APN 226-150-027 PARCEL SIZE AND USE APPLICATION# <br /> OWNER NAME Fredrik's Nursery I ��K� (� (� PHONE N <br /> OWNER ADDRESS '-3223.5.Austin Rood ` 'r CITY/STATE/LP Ripon,California <br /> CONTRACTOR Krazan R Associates,Inc. PHONE 559348.220U <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATEIZJP Clovis.California 93612 <br /> SUBCONTRACTOR KmearI 3 Associates,Inc PHONE 559.348 2200 <br /> SUBCONTRACTOR ADDRESS Dak1':t:+/1 v.�1in'• CITYISTATEIZJP Clovi: u:0.1nrni.a 93612 <br /> LICENSE -y'C-57 C-61 D-09 Other NUMBER I' I1' EXPIRATION DATE 10312018 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) 1 Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED UsE Domestic/Private ImgationlAgricultural Industrial it 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 Boring(s) M of bo-gs /Geotechnical w of boongs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair T-1—�':I. <br /> New Pump Pump Replacement Pump Repair Raise Well Casio <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary V Auger Cable Tool !:Push Point Other <br /> Proposed Well Depth J5 I—'YO' <br /> -'YOr f1 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 Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Deptht5 ��O it If Neat Cement(941b bag/5-10 gal water) Sand Cement sack mixt]gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width It Length If Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Se! ft Standing Water Level R <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 /> -1411NINIUM 48 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE kl'inaging Fn',1111et'r DATE 09,262016 <br /> - - MENT <br /> VED <br /> 8 ?018 <br /> co�N <br /> NT'4t 7 <br /> TMFNT <br /> PA TMENT U E OtilLy <br /> Application Accepted By D to Area'E'�i--'--'-- Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By�J Date >✓ ( / Constructed Well Depth ft <br /> COMMENTS L�- <br /> PE SC Received Check Amount Date Permit/ Invoice# WellID# <br /> Codes Info Remitted Aervicq Re uest# <br /> 37 <br /> 1r'o s <br /> EHC 43-06 remised 4114118 WELL.'PUMP PERMIT <br />