WP0041558 - Laserfiche WebLink

Home Browse Search

: ;WELL CONSTRUCTION— Pu Replacement In ia(ileiLd t_c IiIrsciWell Casing = New Pump 2 , ia i Drilling Method _ .vii.id Rotary I Proposed Well Det-,•th____________ft Excavation _ in diameter _.: Open Bottom • ,._ Gravel Pack/Gravel Size in diameter _ Conductor Casing in diameter / Conductor Casing Depth ft ! Well Casing Diameter in Thickness/Gauge/ASTM Sched _ _. Steel ... Plastic _. Stainless Steel u Other Grout Se.al Depth___•__ ft 7, Neat Cement (94/b bag/5-10 gal waiei) Ti Sand Cement sack mix/7 cal water = Bentonfte (29% solids) = Other : Grout Placement Method - Pumped Ti Free Fall F Other 7- Retardant / Accelerator (name) PEDESTAL Installed By 2 Driller = Pump Contractor = Other _. Concrete Pedestal ,Dirnensions: Width ft Length ft Thick in _ Christy Box Stove Pipe ._ Air Rotary _ Auger _ Cable Tool L. Push Point _ Other !OWNER ADDRESS 2- 7102 1 h bin !CONTRACTOR -1I73- g n I CONTRACTOR ADDRESS51) -174 f(C/ :SSMiaCIV 3.11S WELL/PUMP P ER miT SAN jOAQUIN COUNTY' ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE- STOCKTON CA 95205 -6232 (209) 468-3420 NON-REFUNDABLE PERMIT 14; EXPIRES 1 Y FROM DATE ISSUED 1 .108 ADDRES:i T-1 rfi /j7/ 3. CROSS STREET 12er 121C-) APN 0 a/ d 1 3 3 j- PARCEL SIZE /A,USE APPLICATION # CITY/ZIp Horn 5(t.) OWNER NAME or one 014 fr" P - 76 q b32.... HO E6-.9 aoRo CITY/STATE/ZIP " 0 VT() BILUNG PARTY: - OWNER XGONITRAcToR 7 SuscONTRAcTOR/CoNsuLTANT noMESTIC WELL SAMPLING: Genera) Mineral/Conform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) ! VENDEO.LISE )mestic./Private Irriaation/Agricultural _ Industrial _ Water Quality Monitoring _ Soil Sampling/Characterization _ Public Water System If different from Owner. Water System Name Contact Name or Phone Number I'l PE OP MIRK _ New Well ... Replacement Well _2 Well Alteration/Modification . _ Other - Monitoring Well(s) # of wells - Soil Boring(s) # of borings - Geotechnical # of borings ... Out-Of-Service Well - ut-Of-Service Well Renewal _ Cross-Connection Repair PUMP )(Submersible - Turbine 7 Other HP Pump Set ft Standing Water Level HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN ,IOACtUIN COUNTY ORDINANCES. STATE LAWS, AND RULES AND REGULATIONS. ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT ANiD ACTIVE 'MTH THE Alr; !FORMA CONTRACTORS' STATE LICENSE BOARD AND THAT AM IN ,:!OIVIPLIANCE WITH. ALL WORKERS COMPENSATION LAWS. MNMJJM 4 OUR ADVANCE NOTiCE RECIURED FO INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE - o C) niciyi DATE !----1 I I i i I _ --t i -.F hug!, lir "P H- I L 1 -i— i .ye, 1/0, I./ I I 1 i vc r 4.•.; /IV:et in _L 41 2,9 I I : _.....loorm" :gr. ! 1 ......H,_ i __ S 1 <iv i , ---, . -i-- 4- _,............4....,- 1_1_ _ r , . i i .# --F— • ___i_ , I--- __t__ L__ _i__ 1 --i- I . 111111111 111111111111111111111111111 Application Accepted By Grout Inspection By Pump Inspection By Soil Boring Inspection By COMMENTS DEPARTMENT USE ONLY Date /?/.32/0/0.00 Area 11/C1(i Employee ID# F IZ Date 0 SPECIAL Well Permit cres(•6(...: 2- Date iiiv2.1 WAIVER Received Date Constructed Well Depth ft PE Codes SC Info Received 13)1 CFc!..!2Mb ash Amount Remitted Date Permit/ Service Request # Invoice # Well ID# 9 3 gd 050 41.1, - ,?/-32-/ 477 P- 2-/A) wroolft55 CITY/STATE/ZIP I SUBCONTRACTOR/CONSuLTANT /A( 19 SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP --1 ! LICENSE _ C-57 Vei C-61 031p(pob _ D-09 _ Other NUMBER F_XPRATIO SIGNED_ EHD 43-06 6/11/2019 WELL /PUMP PERMIT