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WELLIPUMP PERMIT <br /> SAN JOAQUIN 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 /> 3280 W.Grant Line Road CITY21P y'Trac CA LA <br /> / im <br /> CROSS STREET <br /> Lammers APN 238-600-42 PARCEL SIZE}r3b LAND USE APPLICATION# <br /> In <br /> OWNER NAME Savi's LLC S01 V Jt PHONE o? <br /> OWNER ADDRESS 3280 W.Grant Line Road CITY/STATE/ZIP Tracy,CA 95304 <br /> CONTRACTOR Krazan&Associates.Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATE/ZIP Clovis.California 93612. <br /> LICENSE VC-57 C-61 I I D-09 I i Other NUMBER 499908 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/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 Boring(S) #of borings r/Geotechnical 5 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair (10-50 Feet) <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ,Mud Rotary i Air Rotary V.Auger Cable Tool Push Point Other <br /> Proposed Well Depth 10-1 O ft Excavation in diameter I 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 Steel Plastic Stainless Steel Other <br /> Grout Seal Depth )0-'M ft /Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method y Pumped I Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller ' Pump Contractor I Other <br /> Concrete Pedestal 'Dimensions:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersibles 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 /> MINIMUM 48 HOU DV CE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED PA TITLE Managing Engineer DATE 10/27/2020 /I A <br /> C�V�r <br /> L'D <br /> 30 2zo <br /> A Uwv MENT ANT y <br /> 'PAR TMENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By LL Date d AV Area Employee ID# DA <br /> Grout Inspection By Date 11 AMW SPECIAL Well Permit <br /> Pump Inspection By Date t I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth / ft <br /> COMMENTS JJ CIM '/ l -y is <br /> entj nPered Irei e , <br /> PE SC Received Chec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Remitted Service Re uest# <br /> la Iso .3 !p l- 1 0 <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />