WP0041626 - Laserfiche WebLink

Home Browse Search

JOB ADDRESS 2751 S. Bacon Island Road CITY/ZIP Stockton. California CROSS STREET Bacon Island Road ApN 129-05-015 PARCEL SIZE LAND USE APPLICATION IX Delta Wetlands Properties AIPITO irst.)(i i 4'T D,,t, ,,t ,-1 .....„, , :e.- ) <- 1 i. PHONE CITY/STATE/ZIPa 10)- nrirt7/14e1ifl7M174.4 6 (700 ...7 II ..V.., /-, r , , e• PHONE 916-638-1169 CONTRACTOR ADDRESS 3000 Duluth Street CITY/STATE/ZIP West Sacramento, California 95961 SUBCONTRACTOR/CONSULTANT Hultgren - Title Engineers PHONE 925-685'6300 SUBCONTRACTOR/CONSULTANT ADDRESS 4085 Nelson Avenue, Suite A CITY/STATE/ZIP Concord. California 94520 LICENSE i C-57 C-61 D-09 Other , NUMBER 1058336 EXPIRATION DATE 09/30/2021 BILLING PARTY: OWNER OR XBCONTRACTOR/CONSULTANT OWNER NAME OWNER ADDRESS CONTRACTOR 1660 Olympic Blvd., Suite 300 Cascade Drilling i> 0 0, s-31 Ds- ENT VED 71121 PAY M ECE ..AN Z WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE • STOCKTON CA 95205 -6232 (209)468-3420 NON-REFUNDABLE PERMIT www.sjgov.orgiehd EXPIRES 1 YEAR PROM DATE iSSUED DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) INTENDED USE - Domestic/Private -- Irrigation/Agricultural - Industrial - Water Quality Monitoring 7/ Soil Sampling/Characterization Public Water System II different from Owner Water System Name Contact Name or Phone Number TYPE OF WORK New Well = Replacement Well Well Alteration/Modification ' Other .. Monitoring Well(s) # of wells _ Soil Boring(s)N of bonngs if.' Geolechnical ,./3" C' N of borings - Out-Of-Service Well --- Out-Of-Service Well Renewal Cross-Connection Repair - New Pump "-- Pump Replacement -- Pump Repair - Raise Well Casing WELL CONSTRUCTION Drilling Method Mud Rotary .. Air Rotary Auger . Cable Tool Push Point Other Proposed Well Depth 5° ft Excavation in diameter = Open Bottom = Gravel Pack/Gravel Size in diameter -- Conductor Casing in diameter / Conductor Casing Depth It Well Casing Diameter 6 in Thickness/Gauge/ASTM Sched Steel Plastic -.: Stainless Steel • Other Grout Seal Depth ,S it X Neat Cement (94 lb bag/5-10 gal water) Sand Cement sack morl7 gal water Grout Placement Method )( Pumped = Free Fall Other _ Bentonite (20% solids) _ Other Retardant / Accelerator (name) null& Installed By - Driller - Pump Contractor - Other Concrete Pedestal Dimensions Width ft Length ft Thick in Christy Box Stove Pipe :SS32100V ILJS PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level 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 CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. SIGNED /19' TITLE Project Manager DATE 1/19/21 MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SAN JOAQU IN E %/IRON HEALTH DE COU VTY EN TA_ RTMENT DA DEPARTMENT U,SE QNLY OP I ? DA Application Accepted By Date ;/ Area Employee ID# Grout Inspection By Date SPECIAL Well Permit Pump Inspection By Date .... WAIVER Received Soil Boring Inspection By ()Z15of---. Date '7A 2.07 \., Constructed Well Depth ft COMMENTS LC' ( `,••• `), s s A, - RE Codes SC Info Received B „, Ch+ck#1 , Cash Amount Remitted Date • Permit/ kervice Request ft Invoice # Well ID# 9 701 1 f_.-) p 1/ t;it t I i 10i 1 it! tAi Voot-i I L/7-(/ (•4+•• it 9 1 cr sr.? y EHD 43-06 6111/2019 WELL /PUMP PERMIT