Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HeAITH DEPARTMENT ins ENT HAZELTON AVENUE-STOCKTON CA 95203.6272(209)466.3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.orgfehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 915 E 11th Street CIrYlZIP Tracy.CA 45976 _ rry�yy <br /> CRO53STREET Fast Street APN 23337010 PARCEL SIZE,,) r LAND USE APPLICATION Y A <br /> OWNER NAMETract/�ifl+3dch-o41 DiGtrict _ PHONE209-830-3200 <br /> OWNER ADDRE58 1875 W Lowell Avenue .._- CrtvfSTATEmp Tracy,CA 95376 <br /> CONTRACTOR Middle Earth Geo Testing Inc. PlfoNe 714-633-5025 <br /> CONTRACTOR ADDRESS 954 N Lemon Street CrrYrSTATEMP Orange, CA 92767 <br /> SUBCONTRACTOR)CONSULTANT RCK Accnrlatec PHONE 916-853-9293 <br /> SOBCONTRACTOR)CONSULTANTADDRESS 3140 Gold Camp Dr.#160 CfTY1STATE/7JP$anCh0 Cordova CA 95670 <br /> LICENSE -<C-57 C-61 0-09 OI`.er_ _.__ NUMBER 899451 EXPIRATION DATE_0LNj2021 <br /> BILLING PARTY: OWNER CONTRACTOR ;{ SUBCONTRACTORICONSULTAHT <br /> DOMESTIC WELL SAMPLING: General Ki,neral/Coliform Bactona(4391) Dibromocllloropropane(4392) Arsenic(4393) <br /> INTENDED USE DomesliaPnvatu IrngationrAgfCuIIUral Ineostnal Writer Quality Monitoring X Sal Sampiing'Chamcterizallon <br /> Public Water System <br /> It C.11-1411—0-1 W.'x SrA—Nx'• Ccn1a[i Nunn Pm,e Nwneer <br /> TYPE OF WORE( Now'11e11 Replacement well Well ARereuory Modfrcabon Other <br /> Mon,todng W01(s) 0 of Weiss Sat ec mg(s) X Geotechnical_ •°'t rg. <br /> Out-Of-Se"Ica Well Out-Of-Servlcn Well Renewal Cross-Connocbon Repair <br /> Now Pump_Pump Roplacdment Pump Ropair __ __. Raise WRIT Casln2 _ <br /> WF.LLCONSTRUCTION <br /> Drilling Method Mud Rolary As Rotor), ;i Auger Catlo 7col Push Pomt Doles <br /> Proposed Well Dupth 50 it Ercaval cm 1.5 in ammeter Open Bottom Gravel PackrGravol Sao In memerur <br /> Conductor Cosing in diameter I Conductor Casing Depth 0 <br /> Well Casing Dinmotaf_in Thirkness'GaAa/AST1.1 Schad___ Steel PLTslir. Stainless Stnel Omer <br /> Grout Seal Depth 50 it Y.Neat Cement(94 Ib NO 10 gal Haver) Sand Cement sack mur7 gal water <br /> Bentonne(201:Sol ds) Other <br /> Grout Placement Method Pumped Free Fall :!Other CPT red Sllremmi0 ReLirdant/Aeceiorator(,ionic) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width R Lergth ft Thick in Christy Box Stove Pipe <br /> PUMP Si,lbma eihle Twb.ne Other HP____ Pump Sol R Stnnding Water Lovel R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WALL 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 VE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS CO. O S. <br /> �UVAN-- TICE REQUIRED F R INSPECT Gid�L/P SSE CAL7J1_'(209)9.`3-769. <br /> SIGNED TITLE dam'"`O LI"L 'DATE -1-�!A-2"-b <br /> RE SMF <br /> i CFjV�T <br /> - - - - 30 <br /> oq Q� ?020 <br /> DEPARTMENT USE.ONLY <br /> �/ / <br /> Application Accepted By /�L'Z— Date 7 � t] L _ Area yc%L Employeo IDN <br /> Grout Inspection By Data SPECIAL Well Permit <br /> Pump Inspection ByAA// _ Data ,,/ WAIVER Received <br /> Soil Dormg Inspecilon Sy y'� i'Ti b/Date W21 Z C Constructed Wall Depth It <br /> COMMENTS <br /> PE SC Received Chef Amours Date Permit/ Invoice 0 Wall IDS <br /> Codes Info (Remitted lu Re uast S <br /> EnO.x�, ell]OH -i.rll lulli`PEPJII <br />