Laserfiche WebLink
r <br /> t WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> t y <br /> JOB ADDRESS Oakcw a e VV <br /> r MIstrlot CITY/ZIP Manteca 95337 m <br /> q.lq o <br /> CROSS STREET Bella Laao Way APN 2415201j, PARCELSIZE 6.25 acres LAND USE APPLICATION# �n <br /> N <br /> w <br /> OWNER NAME Dewberry I Drake Haglan PHONE_(209)707-3330 <br /> WNER ADDRESS 903 West Center Street,Suite 1 CRY/STATE/ZIP Manteca,CA 95337 <br /> CONTRACTOR ENGEO Incorporated PHONE (562)472-43513 <br /> CONTRACTOR ADDRESS 17278 Golden Valley Parkway CRY/STATE/ZIP <br /> SUBCONTRACTOR/CONSULTANT '\/aW F-)rillincl PHONE (209) 369-9600 <br /> SUBCONTRACTORICONSULTANTADDRESs 3806 Duck Creek Dr CrrYISTATE/ZIP Stockton, CA 95215 <br /> LICENSE C-57 C-61 D-09 Other NUMBER ExPIRATION DATE <br /> BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DoMEsncWELL SAM PLING: 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 System Name contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> MonitoringWell(s) fl of wells SoilBoring(s) #afbonngs Geotechnical 3 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> NewPump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth "60 ft Excavation 4-6 inches diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth it Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Methodumpe X Free Fall Other ear ant Accelerator name <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft <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 CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS <br /> COMPENSATION LAWS. <br /> MINI UM 48 HOUR A VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> pq yM <br /> ECE��NT <br /> FD <br /> o/V <br /> lV QU/N <br /> q-To UNTY <br /> MINT <br /> A(R MENT U E ONLY <br /> Application Accepted By ate Area Employee ID f.�� <br /> Grout Inspection By Date f SPECIAL Well Permit <br /> Pump Inspection By Dale r 1 WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received ChecW Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B —C—a—sh Remitted Service Request# <br /> Ail a S <br /> EHD 43-06 6/11/2019 WELL/PUMP PERMIT <br />