Laserfiche WebLink
+ WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3566 w 11th street CITYIzIP Tracy,95304 m <br /> S Kasson Rd 23906018 D <br /> CROSS STREET APN PARCEL SIZE 41 ac. LAND USE A PLICATION# z <br /> p <br /> m <br /> OWNER NAME 1 .2- r n Pfd" jP,, e,/,_Pt PHONE <br /> Jr—. '75-3-72 W <br /> OWNER ADDRESS Sy i V C'i L��) CCITY/STATE/ZIP1 L / <br /> GV . `�A /5-3-7 2 N <br /> a <br /> T <br /> CONTRACTOR Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/$TATE/LP Fresno,California 93722 <br /> SUBCONTRACTOR/CONSULTANT Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 4729 West Jacquelyn Avenue CITY/STATE/ZIP Fresno,California 93722 <br /> LICENSE i/C-57 I C-61 I I D-09 i Other NUMBER 970772 EXPIRATION DATE 3/31/2022 <br /> fy <br /> BILLING PARTY: OWNER i CONTRACTOR h+SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:I i General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)1 1 Arsenic(4393) <br /> INTENDED USE I Domestic/Private i Irrigation/Agricultural I Industrial i Water Quality Monitoring of Soil Sampling/Characterization <br /> 1 Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> fv <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> I Monitoring Well(s) #of wells V Soil Boring(s) 4 #of borings I Geotechnical #of borings <br /> I Out-Of-Service Well 1 1 Out-Of-Service Well Renewal I I Cross-Connection Repair <br /> I New Pump Pump Replacement I Pump Repair I Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud P-1— Air Rotary V Auger Cable Tool Push Point Other <br /> Proposed Well Depthft Excavation in diameter I Open Bottom :I Gravel Pack/Gravel Size in diameter <br /> I Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic I i Stainless Steel 1 i Other <br /> Grout Seal Depth 30 tO 50 ft V Neat Cement(941b bag/5-10 gal water) Sand Cement Sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method I Pumped Free Fall V Other Tremmle I Retardant/Accelerator(name) <br /> PEDESTAL Installed By I Driller I Pump Contractor I Other <br /> Concrete Pedestal (Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP 1 Submersible Turbine 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 COMP NSATION LAWS. <br /> MI 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Geotechnical Staff Engineer DATE 10/8/2020 <br /> q YM <br /> CES��T <br /> 0 <br /> T 16 ?020 <br /> PUgR�r ANT y <br /> MENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By G Z Date J 6 ON Area $ << Employee ID# DA <br /> Grout Inspection By Date Z 1: SPECIAL Well Permit <br /> Pump Inspection By Date I I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft LL <br /> COMMENTS `S 0 <br /> 2 t AS� <br /> PE SC Received Chec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B admitted Service Re uest# <br /> EH043-D6 6/112019 WELL/PUMP PERMIT <br />