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r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)4118-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7910 Longe Street CITY21p Stockton,95206 <br /> D <br /> CROSS STREET Stimson Street APN 17726035 PARCEL SIZE 5.14 LAND USE APPLICATION III z <br /> OWNER NAME Craig Walters PHONE 209-982-5585 w <br /> OWNER ADDRESS 7910 Longe Street CITY/STATErZIP Stockton,CA 95206 CD <br /> 00 <br /> 00 <br /> CONTRACTOR Salem Engineering Group,Inc. PHONE 559-271-9700 CD <br /> r <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/STATE/ZIP Fresno,California 93722 <br /> SUBCONTRACTOR/CONSULTANT Salem Engineering Group,Inc. PHONE 559-271-9700 0 <br /> SUBCONTRACTOR/CONSULTANTADDRESS 4729 West Jacquelyn Avenue CITY/STATE/LP Fresno,California 93722 <br /> W <br /> Q <br /> LICENSE �/C-57 J C-61 L D-09 I Other NUMBER 970772 ExPIRATION DATE 3/31/2020 fD <br /> BILLING PARTY: I OWNER I CONTRACTOR V SUBCONTRACTOR/CONSULTANT y <br /> p. <br /> DOMESTIC WELL SAMPLING:..-General Mineral/Coliform Bacteria(4391)C Dibromochloropropane(4392) Arsenic(4393) v, <br /> INTENDED USE DomestictPrivate i Irrigation/Agricultural i Industrial Li Water Quality Monitoring Vr Soil Sampling/Characterization �n <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well i Replacement Well I Well Alteration/Modification i Other <br /> Monitoring Wells) #of wells i_i Soil Boring(s) #of bonngs V<Geotechnical TWO #of bonngs <br /> Out-Of-Service Well I Out-Of--Service Well Renewal I Cross-Connection Repair <br /> L:New Pum Pump Replacement LI Pump Repair Raise Well Casing �• <br /> WELL CONSTRUCTION <br /> Drilling Method C Mud Rotary i I Air Rotary 1d Auger I Cable Tool ❑Push Point I Other <br /> Proposed Well Depth n/a ft Excavation in diameter ❑Open Bottom II Gravel Pack/Gravel Size in diameter <br /> L'Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad 17 Steel I Plastic I I Stainless Steel F Other <br /> Grout Seal Depth 20 to 25 ft ✓Neat Cement(94 lb bag/5-10 gal water) I Sand Cement sack mixf7 gal water <br /> Bentonite(20%solids) 1 Other <br /> Grout Placement Method :_l Pumped V Free Fall J Other Tremmie ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By -I Driller Pump Contractor Other 1 <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in i Christy Box I'Stove Pipe l <br /> PUMP z Submersible:i Turbine _.Other HP Pump Set It Standing Water Level It <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/48HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED as/GG� Ll.G�fi TmE Geotechnical Staff Engineer DATE 5/19/2020 <br /> did <br /> EENT <br /> I vFD <br /> 2 ?020 <br /> l ENTq NTY <br /> R r414111 <br /> DEPARTMENT USE ONLY <br /> v <br /> Application Accepted By t� Date S z ZZOG J Area v, C Employee ID# S K <br /> Grout Inspection By Date I.1 SPECIAL Well Permit <br /> Pump Inspection By Date IA WAIVER Received <br /> Soil Boring InsRection By _ Date Constructed Well Depth _itCOMMENTS I C.Q.tYI VQA-) r It egg _b� <br /> PE SC Received Amount Permil/ <br /> Codes Info By— Cash Remitted Date Service Re u #1 Invoice# Well ID# <br /> 113-7d -o <br /> EHD 43-06 6/112019 WELL(PUMP PERMIT <br />