Laserfiche WebLink
CONTRACTOR ADDRESS 3000 Duluth Street <br />SUBCONTRACTOR/CONSULTANT Hultgren - Tilhs Engineers <br />CITY/STATE/ZIP West Sacramento, California 95961 <br />P HONE 925-685-6300 <br />NAUSCONTRACTOR/CONSULTANT OWNER BILLING PARTY: N-Gererferaeseart- <br />15500 W Bacon Island Road ciTyyzip Stockton, California <br />PARCEL SIZE 1 Li LAND USE APPLICATION It <br />Delta Wetlands Properties fl() eFcrVAC. i-er ;L:t PHONE <br />1660 Olympic Blvd., Suite 300 S-9/ s-3 cirosTATEmii-YtZT-L:4::::5.1:419€ g00s-E1 <br />P HONE 916-6381169 <br />Joe ADDRESS <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />SUBCONTRACTOR/CONSULTANT ADDRESS 4085 Nelson Avenue, Suite A <br />LICENSE C-57 C-61 D-09 Other <br />CITY/STATE/ZIP Concord, California 94520 <br />NUMBER 1058336 EXPIRATION DATE 09136'2021 <br />CROSS STREET Bacot) Island Road ApN 129.05-027 <br />Cascade Drilling <br />New Well Replacement Well <br />Monitoring Well(s) # of wells <br />Out-Of-Seivice Well <br />New Pump Pump Replacement <br />Soil Boring(s) <br />Out-Of-Service Well Renewal <br />Pump Repair <br />Geotechnical.14. 45 Eofboringn <br />Cross-Corinection Repair <br />Raise Well Casino <br />PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br />sack nnxi7 gal water <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary / Auger : Cable Tool Push Point Other <br /> <br />Proposed Well Depth 25 .. ::-,f ") It Excavation in diameter Open Bottom Gravel Pack/Gravel Size <br /> <br />Conductor Casing in diameter / Conductor Casing Depth It <br />Well Casing Diameter 6 in ThicknessiGaugelASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth ;I 5: --S fl i Neat Cement (94 lb bag/5-10 gal water) Sand Cement <br />ft Thick <br />PEDESTAL <br />in Christy Box Stove Pipe <br />Installed By -Driller - Pump Contractor - Other <br />Concrete Pedestal Dimensions Width ft Lenc0 <br />in diameter <br />Bentonite 120% solids) Other <br />Grout Placement Method )( Pumped Free Fall Other Retardant ( Accelerator (name) <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 <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />14,11(1(111UM 48 OU ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED /6. TITLE Project Manager DATE 1/19/21 <br />Well Alteration/Modification Other <br />of borings <br />TYPE OF WORK <br />RECEIvui <br />JAN 2. i* 6)21 <br />SAN ..`0AQJIN COUNTY <br />EtsVIRONMENTAL <br />1tEALTI4 DEPARTMENT <br />Soil Boring Inspection By geb, <br /> <br />COMMENTS ;)c, ( tf <br />C t_ <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE • STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.sjqov.orq/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring / Soil Sampling/Characterization <br />Public Water System <br />If different from Owner Water Saver Name Contact Name or Phone Number <br />DEPARTMENT USE,ONLY <br />Area VC <br /> <br />Application Accepted By : (."; Employee 106 --- • , ...--;,7,21. 2- Date iPjAi i <br /> <br />Grout Inspection By Date SPECIAL Well Permit <br /> <br />Pump Inspection By Date WAIVER Received <br />-7.1 ..S I -7_, \ Constructed Well Depth ft <br />CI-) .`-'1\\..)•\ .,K C --,-, c2.----S- - -C-S.----(--'1/4-5F6--`> VYCLAJCI• c...-N <br />.-_?:.(5) - TJ,5 C-S'S.. c2) • <br />PE <br />Codes <br />SC <br />Info <br />Received Checkii/ <br />Cash <br />Amount <br />Remitted Date Permit./ <br />' R quests Invoice # Well ID# <br />'1 ./''t) IS 0 i j ( ,,,, * 0 a? . (1) t' It. IA 11P1S 1..);.k.it <br />( <br />V tr_ Ifcr5106 :ssgriaav 31iS • 9 , <br />EFID 4336 6.11:2019 WELL POMP PERMIT