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941 <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUtrTY ENVIRONMENTA,_HEALTH DEPARTMENT 1863 EAST tiAZELTON AVENUE-STOCKTON CA 95205-6232 (209).:63-3420 <br /> NON-REFUNDABLE PERMIT www.sjyov.org/efid EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7160 Pezzi Rd-_ _ CITYizip Stockton_95215 A <br /> D <br /> CROSS STREET COfT1S10Ck Rd._ _APN 089-05-034 PAR CE_SIZE 1.03 LAND USE APPLICATIONS p <br /> 70 <br /> OWNER NAME Ron Wall <br /> _ PHONE(209)931-5448 <br /> OYdNER ADDRESS ..SAME CITYISTATE.21P <br /> CONTRACTOR Delta Pump,Inc. <br /> - - PHONE(209)466-962_5__ <br /> COWRACTOR ADDRE55 646 S.California St. CITYISTATUZIP Stockton,CA 95203 <br /> SUDCONTRACTOR.ICONSULTANT PHONE <br /> S UECONTRACTOR!CONSULTANT ADDRESS_ CITYISTATEOP <br /> LICE145E x G-cit D-09 Other NUMBER 1055434 ExPfttmm DATE 7/31/2021 <br /> BILLING PARTY: OWNER CONTRACTOR I 1 SUBCONTRACTORtCONSULTANT <br /> DOMESTIC WELL SAMPLING:-1 General Mineral/Colitorim Hacteria(4391)-1 Dibromochloropropane(4392)'1 Arsenic(4393) <br /> )YTENDEDUSE X Domestk:!Pr)vate l IrrigationAgricutrural - Industrial 'Water Ouality Monitoring �_ SOOSampling/Charactervation <br /> I Public Water System <br /> I Jrr.�•r.rrer-Owrai Water Syscon Ndme Gxitdd Name of'harm Nuinte• <br /> TYPE Of Woaik t New Well . Replacement Well Well MleratfonrModification 0)11" <br /> Moniloring Wcllts) #of Tilts - Soil Buri S `*,I n°" <br /> ng( ) r' r Geotechnical °" c <br /> Out-0f-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> -I New Pump L Pump Replacement X Pump Re it Rase Well Casin r <br /> !WELL CONSTRUCTION <br /> i /5Dldiiny Melhud Mud Rotary I_ Air Rotary a Auger U Cable tool _ Push Point _ Other S �Q <br /> Proposed welt Qpth ft CKWVatIOr in diameter I I Open Elottom 11 Gravel Pack,•Gravel Sao_ �[�ENV <br /> I Conductor Casting in diameter ! Corxiuclor Casing Depth <br /> Well Casing Diameter_ in Thlckress!GaugeIASTM r Sched I I Steel Plastic I Stain' ss Steel Other ART ENT <br /> Grout Seal Depth It Neat Cement(94 fb bag15-10 gat water) Sand Cement sack rnrx.'7 gal water <br /> I Bentotile 120%sobds) I Other <br /> Gloul Placemen)Method _ Pumped U Free Fafl Other U Retardant r Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> -1 Concrete Pedestal'IDirnensions Width ft Length ft Thick In Christy Box r Stove Pipe <br /> X Sub(nwsibk:_ Turbine Other HP 1.5 Pump Set It Standing Water Level 8 <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE 1N ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS. AND RULES ANC REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STALE LICFNSF BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKLRS COMPENSATION LAWS. <br /> MINIM UR LIVA CE NOTICE REQUIREU FOR INSPECTIONS -PLEASE CAU.(2091953-7697 <br /> SIGNED Tt �0 <br /> DATE 9/30/2020 <br /> T <br /> tdriveway <br /> ont of garage beside <br /> 1,- <br /> ;� ' 1� 4� �t ✓4.4�� �, 1� <br /> � I <br /> .� � <br /> D E P A R T M E M T I IIS E ONLY <br /> Application Accepted ByyL pate D /3 ,o Atca y�yc� Employee ID# <br /> Grout Irspection By _ Date I SPECIAL Well Permit <br /> Pump Inspection By Tr'/ H(nGtks 19 Odd , '1 Date -2 4 fi b 1 WAIVER Received <br /> Soil Bonng Inspection By Uate Cwl:anN:n•%1'vVell C,Atli ft <br /> COMMENTS <br /> PE SC Received Checkq! Amount PerrnW <br /> Codes Into _ Remitter! DaleService Request if Invoice n Well IDA! <br /> y3s�,t oso 77 Z� <br /> wztl moor rERwr <br />