Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 3232(209)4683420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ohd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2739 S Stockton Street <br /> Crr/LP Lodi. CA 95240 b�D <br /> CROSS STREET W Harney Lane APN 058-130-210 PARCELSIzE8-6ac LAND USE APPLICATION# v <br /> A <br /> OWNER NAME David and Linda Seeman/Ralph and Virqinia Washburn PHONE ra <br /> m <br /> OWNER ADDRESS 2299 Greenbriar Ct Crrr/STATE/7JP Yuba City,CA 95993 <br /> CONTRACTOR West Coast Exploration,Inc PHONE (209)985-7541 <br /> CONTRACTOR ADDRESS P.O. Box 133 Crrr/STATE/LP Escalon,CA 95320 <br /> SUBCONTRACTOR/CONSULTANT Stevens,Ferrone&Bailey Engineering Company, Inc. PHONE (925)688-1001 <br /> SUBCONTRACTOR/CONSULTANTADDRESS 1600 Willow Pass Court Cm/STATE/ZIP Concord,CA 94520 <br /> LICENSE `:r,C-57 - C-61 i1.D-09 Other NUMBER 870761 Ex%RATIONDATE 01/31/2022 <br /> BILLING PARTY: 'OWNER COCONTRACTOR X SUBCONrRACTOR/CONSULTAwr <br /> DOMESTIC WELL SAMPLING:n General Mineral/Coliform Bacteria(4391)n Dibromochloropropane(4392)f Arsenic(4393) <br /> INTENDED USE ❑DomesticfPnvate 'f Irrigation/Agricultural ' Industrial n Water Quality Monitoring X Soil Sampling/Characterization <br /> F]Public Water System <br /> If different from timer. Water System Name Contact Name or Pion Number <br /> TYPE OF WORK n New Well n Replacement Well n Well Alteration/Modification 11 Other <br /> n Monitoring Well(s) #of wells X Soil Bonng(s) 3 #of borings Geotechnical is of borings <br /> n Out-Of-Service Well n Out-Of-Service Well Renewal Cross-Connection Repair <br /> i i New Pum i!Pump Replacement n Pump Repair f Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method n Mud Rotary n Air Rotary XAuger n Cable Tool Push Point Other <br /> Proposed Well Depth 10-20 R Excavation 5 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> F i Conductor Casing N/A in diameter / Conductor Casing Depth N/A R <br /> Well Casing Diameter LUA in Thickness/Gauge/ASTM Schad Steel Plastic f 1 Stainless Steel i i Other <br /> Grout Seal Depth 10-20 R X Neat Cement(94 111 beg/610 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) ❑Other Trac is-f 9,g ndtuato• <br /> Grout Placement Method Pumped X Free Fall X Other is encountered r.Retardant/Accelerator(name) <br /> PEDESTAL I11,, Installed By n Duller -i Pump Contractor n Other <br /> I Concrete Pedestal IIDimensions:Width It Length ft Thick in n Christy Box n Stove Pipe <br /> PUMP N/A Submersibles Turbine �.Other HP Pump Set ft Standing Water Level R <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 /> MIN <br /> ,WUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �1—- TITLE Owner/Operator DATE 06/15/2021 <br /> RFq r� <br /> J cFi�Nr <br /> 104 <br /> Uiy?3 FO <br /> t <br /> DEPARTMENT USE N L Y <br /> Application Accepted By ���G� Data �3 Are. ",Employee ID# _ <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By(� do <br /> Data ?—till2` Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Chec Amount ate Permit/ Invoice# Well ID# <br /> Codes Info B ash Remitted Service Re uest# <br /> 3707 i 0 7,111 <br /> EHD 43-06 6/112019 WELL/PUMP PERMIT <br />