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1201 <br /> WELL/PUMP PERMi i <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)4683420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS 16444 S.Manthey Rd. CITy/Zp Lathrop/95330 rn <br /> A <br /> A <br /> CROSS STREET River Islands Pkwy APN 192-04-046 PARCEL SIZE 1.96 LAND USE APPLICATION# o <br /> OWNER NAME Aron Seus/Eden Garden&Landscape Supply PHONE 209456-1242 <br /> OWNER ADDRESS 16456 S.Manthey Rd. CrrY/STATE/ZIP Lathrop/CA/95330 <br /> CONTRACTOR Delta Pump, Inc. PHONE 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S.Califomia St. crrY/STATE/ZIP Stockton/CA/95203 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CRY/STATElZIP <br /> LIcENSE n C-67 R C-61 — D-09 - Other NUMBER 1055434 EXPIRATION DATE 7131/2021 <br /> BILUNG PARTY: OWNER CONTRACTOR IJ SUBCONTRACTOWCONSULTANT <br /> DOMESTIC WELL SAMPLING:-1 General MineraUColiform Bacteria(4391)-1 Dibromochloropropane(4392)-1 Arsenic(4393) <br /> INTENDED USE '1 Domestic/Private 3i Irrigation/Agricultural - Industrial -1 Water Quality Monitoring F Soil Sampling/Characterization <br /> I Public Water System <br /> If different from r%vier. Water System Name Contact Name or Phone Number <br /> TYPE OR WORK I New Well I Replacement Well Well Alteration/Modification Other <br /> -1 Monitoring Well(s) #of wells - Soil Boring(s) #of bonngs n Geotechnical #of borings <br /> I Out Of Service Well Out Of Service Well Renewal Cross Connection Repair <br /> -i New PUMP L Purrip Replacement bt Purnp Repair _ Raise Well Casin <br /> WELL CONSTRUCTION <br /> Drilling Method :J Mud Rotary L Air Rotary U Auger U Cable Tool _ Push Point _ Other <br /> Proposed Well Depth It Excavation in diameter I I Open Bottom I I Gravel Pack/Gravel Size in diameter <br /> :J Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched I I Steel Plastic I i Stainless Steel Other <br /> Grout Seal Depth ft _ Neat Cement(94/b bag/5-10 gal water) _ Sand Cement sack mix/7 gal water <br /> I Bentonite(20%solids) 1: Other <br /> Grout Placement Method _ Pumped U Free Fall _ Other U Retardant/Accelerator(name) <br /> (PEDESTAL Installed By - Driller - Pump Contractor Other <br /> 1 Concrete Pedestal rlDimensions:Width ft Length R Thick in - Christy Box n Stove Pipe <br /> PULP X Submersible_ Turbine _ Other HP 1 Pump Set ft Standing Water Level 7-ft <br /> 1 HEREBY CERTIFY THAT 1 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 UCENSE IS <br /> CURRENT AND ACTIVE WITH THE CAUFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> M I Ph 08 H 1UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SK3NED TITLE CEO DATE 1/4/2021 <br /> OR <br /> s <br /> IL <br /> AA <br /> rAlk <br /> 47" FST 1 it�3ra,l b tIU` ©C4 <br /> ar F Mbe Tic <br /> Pwi� <br /> U .Jk' '.' {: <br /> �--�^ DEPARTMENT USE ONLY <br /> Application Accepted By Date 1 /d v;? Area -S Lrn i ut' Em &m* <br /> Grout Inspection By Date I SPECIAL Well P �1v <br /> Pump Inspection By �'�K1 J I �n c /v.1.'L Date 2l 23 61 i I WAIVER ReceZ 1 P <br /> Soil Boring Inspection By Date Constructed Well Depth 1`I 1 20 <br /> ft <br /> COM MLNIS ,tr Cf �Il �f 4,,fA )2 t; Inllrl elm ayCOUNT`f <br /> SM ErNt p MEN MENT <br /> PE SC Received Amount Date Permit/ Invoice# H Well ID# <br /> Codes Info C sh Remitted rvice Request# <br /> 3 477 <br /> EHO 43-06 6x112019 WELL(PUMP PERMIT <br />