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,t/I,��c �/�� IVELUPUMP PERMIT <br /> SAN OAOUIN CO NTY ENUNMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)4663420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> t N <br /> JOB ADDRESS Mountain House Parkway.South of Wicklund Crossing Way CITY/ZIP Mountain House /95391 <br /> ^� �J 1 p D <br /> CROSS STREET Wicklund Crossing Way APN KS Io 5,w��M4 PARCEL SIZE LAND USE APPLICATION# A <br /> OWNER NAME Panattoni Development Company,Inc. IlLi araC (�0/YJnit,,,71l ePHON l H <br /> �. fp Q IMTA// PD' [`Q e Z S Z1 57D C <br /> OWNER ADDRESS 8775 Folsom Boulevard,#200 �Al -15— .Y� � T1�2�Sacramento,CA 95826 <br /> CONTRACTOR West Coast eSDIOl8110n PHONE 209.985.2663 d <br /> CONTRACTOR ADDRESS P.O.Box 133 CITY/STATE/ZIP Fscalon,CA 953202,11 <br /> �. <br /> n O <br /> SUBCONTRACTOR PHONE r=n <br /> 1 CD <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP -V <br /> d <br /> X <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 870761 EXPIRATION DATE 01/31/2018 < <br /> m <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring XSoil Sampling/Characterization <br /> Public Water System S <br /> If different from OwnerWa er system Name L;ontaCt Name or ane NUMber C <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> d r' <br /> Monitoring Well #of borings <br /> Well(s) #of wells Soil Boring(s) X Geotechnical 8 #of bongs F <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> Eump Pump Re lacemen Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> O <br /> Drilling Method Mud Rotary Air Rota X Au Cable Tool Push Point Other <br /> Proposed Well Depth5-),0 ft Ex Ion 4 1/2 in diameter Open Bottom Gravel Pack/Gravel Size in diameter n0 <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 full depth It X Neat Cement(94 lb bag/5-10 gal wafer) Sand Cement sack mixf7 gal water <br /> JJ Bentonite(20%solids) Other <br /> Pum <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) fv <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:O� Width ft Length It Thick in Christy Box Stove Pipe o c <br /> w <br /> n PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft fD <br /> \/ 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN y <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS p <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL ^ <br /> WORKERS COMPENSATION LAWS. "o <br /> MI M 2 HOUR DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLEVice President��i��Services DATE 12/27/17 <br /> A, " <br /> VNr eb <br /> Z0- 2 8 ?01I <br /> iA <br /> ONMFNTUN� <br /> EPgRTjy kT <br /> AL <br /> DEPARTMENT USE ONLY <br /> Application Accepted By - Date Z -1� 7 Area S Employee ID# A h mC <br /> Grout Inspection By Date t / r /I Y SPECIAL Well P@Rttlt <br /> Pump Inspection By Date f� - WAIVER Received <br /> M J / Soil Boring Inspection By Date C [rutted ell Depth ft <br /> 1'1 1yrT ( COMME TS 96 � <br /> PE SC Receiv d Chec Amount Date Permltl Invoice# WeIIID# <br /> Codes Info B ash Remitted Service Re uest# <br /> "741ISc 153 02� <br /> r. <br /> EHD 43-06 <br /> WELL/PUMP PERMIT <br /> 4/30/12 <br />