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707-741-1761 PHONE CONTRACTOR Underground construction Co. <br />CRY/STATE/ZIP Benicia, CA 94510 CONTRACTOR ADDRESS 5145 Industrial Way <br />PHONE 510-509-4993 C SUBCONTRACTOR/CONSULTANT orrpro Companies Inc.., <br />2625c Barrington Court CRY/STATE/ZIP Hayward Ca 94545 SUBCONTRACTOR/CONSULTANT ADDRESS <br />CONTRACTOR /SUBCONTRACTOR/CONSULTANT OWNER BILLING PARTY: <br />Joe ADDRESS—"ST21 Davis Rd. (GPS: 38.029754. -121.331832) neeke3 va3 car/zip Stockton CA 95209 <br /> <br />APN 07a 2016 , PARCEL SIZE ,6iC LAND USE APPLICATION # crt.49 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STocicroe CA 95205-6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.or /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />PHONE <br />OWNER ADDRESS City Hall, 425 N , El Dorado St CITY/STATE/ZIP Stockton, CA 95202 <br />LICENSE VC-57 C-61 D-09 Other NUMBER 764678 EXPIRATION DATE 06/30/2021 <br />THORNTON RD <br />CROSS STREET <br />OWNER NAME City of Stockton <br />PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br />SIGNED <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 HOUR ADyAN9E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE Construction Manager DATE 12/27/2020 <br />Grout Placement Method Pumped Free Fall Other Retardant / Accelerator (name) <br />ft Thick <br />PEDESTAL <br />In Christy Box Stove Pipe <br />Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length <br />WELL CONSTRUCTION <br />Drilling Method 1/Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth 200 ft Excavation 8" in diameter Open Bottom I/Gravel Pack/Gravel Size in diameter <br /> <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in ThicknesyGauge/ASTM Sched Steel Plastic Stainless Steel VOther No Casing <br />Grout Seal .pth_ 100_ ft 1/ Neat Cement (94 lb bag/5-10 gal water) Sand Cement <br />V Bentonite (20% solids) Other 100'-3'NEAT CEMENT <br />sack mix 17 gal water <br /> PA yAll ft CEIveco <br /> JAN 2 8 2021 <br />F/4T°H4 D3N o <br />A <br />u <br />N <br />y <br />SA <br />HEAL <br />Af 4 <br />WELL/PUMP PERMIT <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 VOther Ceitylemdk <br /> <br />Monitoring Well(s) # of wells Soil Boring(s) # of &wings Geotechnical 601 bodngs <br />Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br />New Pump Pump Replacement Pump Repair Raise Well Casing <br />DEPARTMENT USE ONLY <br />Application Accepted By ..--141.....L._ Date Area 3/5.t.k.11)"/Employee ID# DA <br />Grout Inspection By .C..."(k..... c i ) lc.; les,,,., 4e:.,t., Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />CpMMENTS Mt Ini Wel I to be ;vi Oh, ute crf P,V15f17.5 leC4thodic t_iftil, nriAl-14 ell to <br />De . red.' v.-1-k <br />PE <br />Codes <br />SC <br />Info <br />Received Check#/ <br />Cash <br />Amount <br />Remitted D e Permit/ <br />1A1 <br />mapiestr Invoice # Well ID# <br />4371 iv <br />elp_ <br />16‘,..3.e.___ *307.r. I A sl <br />rul• <br />egx /18777V-li WELL /PUMP PERMIT EHD 43-06 6/11/2019