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It ft Standing Water Level HP 7.5 Pump Set X Submersible Turbine Other 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. / -.DVANCE ""CE FtEOUIPr" r^P INSPECTIONS - PLEASE CALL (209) 953-769 . S ,GNED TITLE CEO DATE 3/3/2021 4.-•-.1, .., .....-, • ....".... ...... ft.-vs. IAN... iorriro*.... war . :,!,---si. '... ' -.--- .............- 4...4.. 4....1r.wIliKr.”.,v--• ...yr,- --..—..-.1.' •• . 14, • , 4 11. 4.-.0 `• ......,. .• I• ..... 4.44-4,4,................."..-... t . . . .. . - .. .... 4-......-- AP *.• ..... .yr N 440% , •••• ,•• •,•••••"••• • ... - ••••••• .... •••••• ••• •• 410•11. ...ar-o•.,Hp•.. v••••-0.41.4r44•••••• l• 0:• • it •%11 tiotiklaZitt• ititt*•••• icia e,•t•:•• • • • • * • • • • .1, 1,1:, • 'it • I 4 4 I • • Z • • • 44 46S : 4kb aiL !•tt•••••" ••• *•••* • j • • .1 • 14 • • .4 • • Sk.II Rd ,Sk.d1 Rd Sk,l, Rd 5,11 RA b • f• 111 • • • I" PUMP 1300 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205-6232 (209) 468-3420 NON-REFUNDABLE PERMIT JOB ADDRESS 22176 E. Skiff Rd. CROSS STREET Temple Creek Rd OWNER NAME Dustin Wagner www.sjgov.orglehd EXPIRES 1 YEAR FROM DATE ISSUED CITY/ZIP Escalon/95320 APN 205-20-002 PARCEL SIZE158 OOLAND U SE APPLICATION # 209-652-5192 PHONE OWNER ADDRESS SAME cmasTATE/zip CONTRACTOR Delta Pump Inc PHONE 209-466-9625 CONTRACTOR ADDRESS 646 S. California St. CITY/STATE/ZIP Stockton/95203 SUBCONTRACTOR/CONSULTANT SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP LICENSE C-57 x C-61 0-09 Other NUMBER 1055434 EXPIRATION DATE 7/31,•2021 BILLING PARTY OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT DOMESTIC WELL SAMPLING: 1 General Mineral/Colrform Bacteria (4391) 1 Dibromochloropropane (4392) 1 Arsenic (4393) INTENDED USE 1 Domestic/Private X Irrigation/Agricultural - Industrial I public Water System (different from Owner. Water System Name - Water Quality Monitoring r Soil SamplingiCharacterization Contact Name or Phone Number PHONE TYPE OF WORK , I New Well I Replacement Well Well Alteration/Modification Other WELL CONSTRUCTION Diillmg Method _1 Mud Rotary L Air Rotary U Auger U Cable Tool _ Push Point ._ Other Proposed Well Depth ft Excavation J Conductor Casing in diameter / Conductor Casing Depth Well Casing Diameter in ThicknessiGaugeiASTM Sched Grout Seal Depth ft _ Neat Cement (94/b bag/5-10 gal water) I Bentonite 120% solids) I Other a „IAYME NT 4 RECEIVED MAR 162 021 JNTY AL VENT # t7.irtris 13 Monitoring Well(s) # of wells - Soil Boringis) it 1 .- Geotechnical Ii Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair U New Pump H Pump Replacement X Pump Repair _ Raise Well Casing in diameter I , Open Bottom I Gravel PackiGravel Size SAENN14011110AC ft HEALTH DEPART I Steel Plastic I Stainless Steel Other _ Sand Cement sack rrrix,7 gal water SUNCIO V 311S Clout Placement Method Pumped ,1 Free Fall Other U Retardant:. Accelerator (name) COMMENTS DEPARTMENT USE ONLY ' Application Accepted By Date Area Grout Inspection By Pump Inspection By Soil Boring Inspection By Date Date Date j NXe i SPECIAL Well Permit I WAIVER Received Constructed Well Depth ISA 5s-itx,)--)Aac /7, PEDESTAL Installed By Driller Pump Contractor - Other -1 Concrete Pedestal -IDimen sion s. Width ft Length ft Thick in - Christy Box 11 Stove Pipe Employee ID// ft PE Codes SC Info Received sc1:1#1; Amount Remitted Date Permit/ Service Request # Invoice # Well ID# /A 02/451 2751--- 315-'2-I WP0011129 END 43-06 6111/2019 WELL /PUMP PERMIT