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1 94 95 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STocKTON CA 95205-6232 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />5606 W _ 1,-1442t.17w RD <br />Awe- J5.3 3502,9 <br />crryizip TRACY 95304 <br />BANTA RD_ APN-253 03 025 PARCEL SIZE <br />SAME <br />CITY/STATE/ZIP <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />SUBCONTRACTOR <br /> <br />Delta Pump _sToCKTON ARMATURE & MOTOR WORKS <br />646 S. California Street <br />CITY/STATEJZIP <br />mia. 209-466-9625 <br /> <br />Stockton, CA 95203 <br /> <br />PHONE <br /> <br />SUBCONTRACTOR ADDRESS <br /> <br />CITYISTATEJZIP <br /> <br />LICENSE 0 C-57 N C-61 0 D-09 0 Other <br /> <br />NUMBER 724778 EXPIRATION DATE 08 /11 <br /> <br />INTENDED USE 0)Nmestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range <br />C Public Water System <br />If different from Owner: <br /> <br />Section <br />TYPE OF WORK C New Well 0 Replacement Well <br />0 Well Alteration/Modification 0 Other <br />C Out-Of-Service Well <br />Monitoring Well(s) # of wells <br />0 Pump Replacement 0 Out-Of-Service Well Renewal <br />CX15(timp Repair <br />O Raise Well Casing <br />1: Soil Boring(s) <br /> of borings <br />O Geotechnical <br />Cross-Connection Repair <br />0 Open Bottom <br />C Conductor Casing in diameter / Conductor Casing Depth <br />Diameter in Thickness/Gauge/ASTM Sched 0 Steel <br />Depth ft 0 Neat Cement (94 lb bag/5-10 gal water) <br />Bentonite (205/e solids) 0 Other <br />Grout Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant / Accelerator (name) <br />I <br />PEDESTAL <br />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 CURRENT AND ACM <br />ALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMP TION LAWS. <br />MINIM <br />SIGNED <br />PUMP/WELL is located <br />behind the house <br />approx. 243.76 ft. from <br />Linnie rd. <br /> <br />NE Ce I E • <br /> <br />1- NOTE: THIS WAS AN EMERGENCY ISSUE OF NO WATER <br />TO THE HOME. WE HAD TO PULL THE PUMP PRIOR TO YOU <br />RECEIVING THIS APPLICATION. WILL NOT HAVE THE PUMP <br />AND WATER LEVELS UNTIL THE JOB IS DONE. <br />Louise Fornos <br />Oltice Manager <br />I Pump <br />New Pump <br />WELL CONSTRUCTION <br />Drilling Method C Mud Rotary 0 Air Rotary 0 Auger <br />Proposed Well Depth <br />JOB ADDRESS <br />CROsS STREET <br />OWNER NAME GENEVIEVE CONINE <br />OWNER ADDRESS <br />Well Casing <br />Grout Seal <br />0xymersible0 Turbine C Other <br />Installed By 0 Driller 0 Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width <br />ft Excavation <br />Water System Name contact Name or Phone Number <br />/ ap <br />0 Cable Tool 0 Push Point 0 Other Aip EA(viii'glifi" co f <br />0 Gravel Pack/Gravel Size 14 '4".ise* 7-44." "a m e t e r <br />, hi 0 ,_ r.i• r <br />ft <br />Plastic 0 Stainless Steel 0 Other <br />C Sand Cement sack mixI7 gal water <br />in diameter <br />ft Length <br />HP 0 75 Pump Set ft Standing Water Level <br />ft Thick <br />3 LAND USE APPLICATION # <br />PHoNE2 0 9 835 5227 <br />in 0 Christy Box 0 Stove Pipe <br />I00:4C4 <br />m <br />> <br />au m o <br />24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> TITLE CEO DATE 5/25/2017 <br />U1SE ONLY <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Bori I p on By <br />COMMEN <br />t <br />Date <br />ft <br />Area Employee ID# <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth A-0 <br />IC,C_Iiesit#2:, I Amount <br />Cash Remitted Service Request # 1.0 <br />c2‘735-6 <br />+ du )31117 sno-7 7 (pi d- <br />PE Sc <br />Codes Info <br />43K - PC° <br />Received <br />By Date Permit/ <br />Invoice # <br />Well 1D# <br />4.5 <br />PARTMENT <br />Date <br />Date <br />b cift.<1 L_ Date <br />year <br />END 43-06 <br />8/04/08 <br />WELL /PUMP PERMIT