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A. Date Date <br />Date <br />WELL/PUMP PERMIT <br />1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED co <br />cirratp FRENCH CAMP 95231 II <br />0 PARCEL sal) . 36 LAND USE APPLICATION # <br />PHONE 8982-1964 <br />762 W. FEDORA AVE., CITY/STATFJZIP ENTCH CAMP 9 2 R 1 <br />Delta Pump -cirorKrroN ARMATTIRF, & MOTOR WORKS 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP S tockton, CA 95203 <br />!SUBCONTRACTOR <br />PHONE <br />SQ9C014TRACTOR AkDoREss <br /> <br />CirrIS't ATEJZIP <br /> <br />, LICENSE C C-57 X C-61 0 0-09 3 Other NUMBER 724778 EXPIRATION DATE 08 /1.11 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section I INTENDED USE xikomestic/Private 0 Irrigation/Agricultural C Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization 0 Public Water System <br />If different from Owner: <br />Lontact Name or Phone Number <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br />C Monitoring Walks) # of wells Soil Boring(s) # of borings # of borings <br />Cl Geofechnical 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair o New Pump 0 Pump Replacement /Rump Repair 0 Raise Well Casing WELL CONSTRUCTION <br />) <br />7.:1 Bentonite (20% solids) 0 Other <br />Proposed Well Depth ft Excavation <br />Drilling Method C Mud Rotary C Air Rotary 3 Auger 0 Cable Tool 0 Push Point 0 Other <br />Grout Placement Method 0 Pumped 0 Free Fall <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched 0 Steel Grout Seal Depth ft 0 Neat Cement (94 lb bag15-10 gal water) <br />C Conductor Casing in diameter / Conductor Casing Depth <br />in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size <br /> ft <br />0 Plastic 0 Stainless Steel 0 Other <br />C Sand Cement <br />Installed By 0 Driller 0 Pump Contractor 0 Other C Concrete Pedestal Dimensions: Width <br />Pump Set (r / ft Standing Water Level la ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN 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 WORKERS COMPENSATION LAWS, <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />CEO DATE 8 /9 /2017 <br />PUMP/WELL IS LOCATED <br />NEXT TO THE DRIVEWAY <br />UNDER THE TREE. SHOULD <br />BE ABLE TO SEE IT FROM <br />THE ROAD. <br />1 9734 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT <br />NON-REFUNDABLE PERMIT <br />JOB ADDRESS 758 W. FEDORA AVE. <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />LOCKHAR T APN1_93-25-023 <br />NORA ALVEREZ 9? <br />Water System Name <br />sack mixf7 gal water <br />in diameter <br />I PUMP xilcSubmersible 0 Turbine C Other <br />1 <br />PEDEsTAL <br />ft Length <br />0 Other <br />HP1 _5 <br />ft Thick <br />0 Retardant / Accelerator (name) <br />in 0 Christy Box 0 Stove Pipe <br />SIGNED <br />TITLE <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />av(K) <br />EPARTMENT U <br />Date <br />Date <br />1 111111111 <br />NLY <br />Area Employee ID#Aitfr)7119 <br />SPECIAL Well Permit <br />WAIVER Received <br />. Constructed Well Depth ft <br />WELL /PUMP PERMIT