Laserfiche WebLink
.r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES')YEAR FROM DATE ISSUED <br /> JOB ADDRESS 17000 East Highway 120 CI1Y/ZIP Ripon,CA <br /> CROSS STREET nQiLk CGNn APN ��� ���r� PARCEL512Esy,i LANDUS <br /> E APPLCATION# D <br /> OWNER NAME The Wine Group PHONE 209-599-0441 <br /> OWNER ADDRESS 17000 East Highway 120 CRY/STATEMP Ripon,CA 95366 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215W.Dakota Avenue Cm/STATEfLP Clovis.California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATE/ZIP Clovis,California 93612 <br /> LICENSE VC-57 C-61 -D-09 -Other NUMBER 499908 ExPIRATION DATE 10.31.2022 <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 System Name Contact Name or Phone Number <br /> TYPE OF WORK =New Well C Replacement Well -Well Alteration/Modification C Other <br /> .�Monitoring Well(s) #of wells -Soil Boring(s) #of borings . Geotechnical 3 #of borings <br /> -Out-Of-Service Well -Out-Of-Service Well Renewal Cross-Connection Repair 30-50 Feet <br /> New Pump Pump Replacement Pumair -Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method -Mud Rotary -Air Rotary /Auger -Cable Tool -Push Point - Other <br /> Proposed Well Depth 30—SD ft Excavation -in diameter -Open Bottom Gravel Pack/Gravel Size In diameter <br /> Conductor Casing in diameter ! Conductor Casing Depot —ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic -Stainless Steel -Other <br /> Grout Seal Depth 30-5-0it Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> -.Bentonite(20%solids) -Other <br /> Grout Placement Method - Pumped - Free Fail Q Other e- -Retardant/Accelerator(name) <br /> PEDESTAL Installed By C Driller -Pump Contractor Other <br /> -Concrete Pedestal--Dimensions:Width It Length It 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORWA,CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. ... <br /> MINIMUM 48 HQ A VA NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 07/06/2021 <br /> D <br /> RE I_ <br /> Ila <br /> N <br /> A ONI T <br /> lHE l Qe?,P, DEPARTMENT USE ONLY �r <br /> 4 Application Accepted By. Date 7 Area -/ Employee ID#A <br /> Grout Inspection By Date - SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Data Z Z Z.\ Constructed Well Depth ft <br /> COMMENTS 7 F�je� r t u ?5 tat 9r fa�rl� w�T}er 13 PH(,�UYI- 6Y�— YQYhY�t1P <br /> ----------------...._._— <br /> PE SC Received Amount a Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Service R .—t# <br /> EHD 43-08 revised 4/14118 WELL/PUMP PERMIT <br />