Laserfiche WebLink
JOB ADDRESS W Stewart Rd _ - cryaw Lathrop,95330 <br />CROSS STREET Lakeside Drive APN 21021001 PARCEL SIZE 92 a c <br />LA N10 USE APPLICATION # a/a <br />OWNER NAME River Islands DeVelopirert LTL PHONE 209-879-7900 <br />73 W. Stewart Road cirasunizip Lathrop,95330 <br />Middle Earth Geo Testing Inc. PHONE (714) 633-5025 CONTRACTOR <br />OWNER ACrtRESS <br />CONTRACTOR ADDRESS <br />SUBCONTRACTOR/CONSULTANT <br />954 North Lemon Street <br />ENGEO <br />Orange, 92867 <br />CITY/STATE/DP <br />PHONE 7605253944 <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br /> 17278 Golden Valley PkvatrosTAniz, Lathrop,95330 <br />LICENSE XC-57 081 D-09 Other <br />BILUNG PARTY: OWNER 0 CONTRACTOR <br />NUMBER 899451 EXPIRATION DATE 6/30/2021 <br />SUBCONTRACTOR/CONSULTANT <br />WELL/PUMP PERMIT <br />SAN JOACHAN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 4232 (209)468-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPUNG: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />JP/TENDED Lin Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />It different horn Owner: Water System Name Contact Name or Phone Number :CS3)30CIV IIIS TYPE OF WORK New Well Replacement Well Well Alteration/Modification X Other Cone Penetration Testing <br />Monitoring Well(s) # of wells . - Soil Boring(s) a ot borings XGeotechnical <br /> 5 ot bonngs <br />Out-Of-Service Well T Out-Of-Service Well Renewal Cross-Connection Repair <br />New Pump Pump Replacement r Pump Repair Raise Well Casing <br />WELL CONSTRUCTION <br />Mud Rotary . Air Rotary Auger <br />Depth ft Excavation in diameter Open Bottom <br /> <br />Conductor Casing in diameter / Conductor Casing Depth <br />Diameter in Thickness/Gauge/ASTM Sched <br />Steel <br /> <br />Depth 'P t ' 100 11 X Neat Cement (94 It bag/5-10 gal waterl Sand Cement <br />Bentonite (20% solids) Other <br /> <br />Grout Placement Method A Pumpet Free Fall A Other .1‘'! w' "1 l '•-- <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions Wdth ft Length ft Thick Christy Box Stove Pipe <br />PUMP <br /> Submersible Turbine Other HP Pump Set ft Standing Water Level It <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 ACI1VE WITH THE CALIFORNIA CONTRACTORS STATE UCENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />48 HOUR ADVAN -'NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Engineer DATE 3/15/2021 <br />/-7 FN.!, <br />DEPARTMENT USE ONLY <br />''--------7 P-:1_,L _ Date 3 /(1 ,J1 ..-.., i 4 : Application Accepted By Area '_:::,./.._ Employee ID* <br />Grout Inspection By A .c>--..,—......,-- Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS 1.-• I pip(' , j'1L' 11 12. td .-;('Cl Of. CArtyk 4T/ f- IC' T'' 1 7- <br />PE <br />Codes <br />SC <br />Into <br />Received <br />By <br />Check*/ <br />Cash <br />Amount <br />Remitted Date PermiV <br />Service Request # Invoice* Well ID# <br />4 ; 3 1 a 15 ) deb-- j/) 6o- 1 - 02411 V 41 J DO 4180 <br />END 4346 6,11/2019 <br />p <br />WELL ?PLAIP PERMIT <br />Drilling Method <br />Proposed Well <br />Well Casing <br />Grout Seal <br />Cable Tool x Push Point Other <br />Gravel Paoli/Gravel Size in diameter <br /> ft <br />Plastic Stainless Steel Other <br />sack r,,,T7 gal water <br />Retardant /Accelerator (name)