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Plastic i Stainless Steel Other _ Sand Cement sack mar7 gal water 1248 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 05205-6232 (209) 468-3420 NON-REFUNDABLE PERMIT www.sjgov.org/ehd JOB ADDRESS 2370 Learned Ave EXPIRES 1 YEAR FROM DATE ISSUED CiTY/Zie Stockton/95205 CROSS STREET Maripoa APN 173-02-015 PARCEL SIZE 0.87 LAND USE APPLICATION OWNER NAME Donna Giacoma PHONE 209-937-0596 OWNER ADDRESS SAME CITY/STATE/ZIP CONTRACTOR Delta Pump, Inc. PHONE 209-466-9625 CONTRACTOR ADDRESS 646 S. Califomia St. CITY/STATE/ZIP Stockton / 95205 SUBCONTRACTOR/CONSULTANT PHONE SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP LICENSE I C-57 x C-61 D-09 Other NUMBER 1055434 EXPIRATION DATE /i31/2021 BILLING PARTY: OWNER CONTRACTOR I 1 SUBCONTRACTOR/CONSULTANT DOMESTIC WELL SAMPLING: 1 General Mineral/Coliform Bacteria (4391) 1 Dibromochloropropane (4392) 1 Arsenic (4393) r s,an joP A A Geotechnical A : : MR 2 1:2:1 V1 7-1. Raise Well Casing Other i I Gravel Pack!Gravel Size Cross-Connection Repair I-IE H i;LNiR/R:CE ft :7ept INTENDED USE X Domestic/Private 1 Irrigation/Agricultural Industrial - Water Quality Monitoring I- Soil Sampling/Characterization i Public Water System If different from Owret Water System Name Oontad Name or Phone Number TYPE OF WORK U New Well I Replacement Well Well Alteration/Modification (I Monitoring Well(s) # of wells Soil Boring(s) fl Out-Of-Service Well Out-Of-Service VVell Renewal U New Pump Pump Replacement X Pump Repair Other 4 it I-.)nr g.; WELL CONSTRUCTION Mud Rotary Depth ft Conductor Casing L Air Rotary U Auger U Cable Tool _ Push Point Excavation in diameter I Conductor Casing Depth in diameter I Open Bottom Diameter in Thick ness,'Ga uge/ASTM Sched I i Steel Depth ft _ Neat Cement (94 lb bag/5-10 gal water) Bentonite 120% solids) I Other Dr illing Method Proposed Well Well Casing Grout Seal Grout Placement Method _ Pumped U Free Fall _ Other U Retardant. Accelerator (name) PEDESTAL Installed By Driller Pump Contractor Other -1 Concrete Pedestal ElDimensions Width ft Length ft Thick in - Christy Box 1 Stove Pipe PUMP X Submersible _ Turbine Other HP 1.5 Pump ft Standing Water Level r--)\._ ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK VVILL 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. ' '1R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) TITLE CEO DATE 2/8/2021 SIGNED :SS321aCIV 311S MAIN HOUSE AND DRIVEWAY PUMP WELL IS LOCATED IN BACK OF THE GARAGE. UNDER LEAN TOO. APROXIMATELY 150 FT FROM RD. BACK DRIVWAY USE THIS DRIVEWAY TO REACH PUMP - - 0 201 Application Accepted By Grout Inspection By Pump Inspection By Soil Boring Inspection By COMMENTS "',) \\?\\:1--\ \X--)%•C3 C>s•-• - Nte -7/4-21Z1Z Date Datec5M/Z-07,1 Date Lriployee ID/4 Eii SPECIAL Well Permit WAIVER Received Constructed Well Depth Area ft PE Codes SC , Info Received 2 . CIC-Cla Amount Remitted IDate Permit/ Service Request # Invoice # Well ID# / q -, ..._ CO c., . ) .A5-3 -;:q- 511512i vvipc)1401 END 43-06 6/1112019 WELL /PUMP PERMIT