Laserfiche WebLink
s, 1 <br />1590 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NUN -REFUNDABLE PERMIT www.sjgov.org/ehd <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />�` Q <br />JOBADDRESS 93d3 1 tom, SkJ,T( ,`C _�.___.____ <br />CITY21P Escalon/95320 <br />CROSS STREET Skiff Rd./Biederman Way APN 205-19-067 <br />__PARCEL SIZE 5.23 LAND USE APPLICATION # <br />OWNER NAME Dustin aaner <br />VV <br />_ __.. _ PHONE 209-652-5192__ <br />OWNERADDRESS 22176 Skiff Rd. _. _ _.. <br />CITYISTATE21PEscalon/95320 <br />CONTRACTOR Delta Pumo CO. <br />PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S.. California St. <br />CITY/STATE/ZIP Stockton/95203 <br />SUBCONTRACTORICONSULTANT _ _ <br />PHONE <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br />CITY/STATE(ZIP <br />LICENSE i C-5' X C-61 D-09 Other <br />NUMBER 1055434 EXPIRATION DATE 713l.`2021 <br />BILLING PARTY: OWNER CONTRACTOR <br />I I SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: -1 General Mineral/Coliform Bacteria (4391) -1 Dibromochloropropane (4392) -1 Arsenic (4393) <br />INTENDED USE 5t Domestic Privato -1IrrigatiorvAgricultural - Industrial 7 Water Ouality Monitoring F Soil SamplingrCharacterization <br />Public Water System ^� <br />f di'fcront iron- n•,wrai. J•;'acei Sgstexn Name Contact Name or Phony Number <br />TYPE OF WORK IJ New Well I Replacement Well Well Alteration/Modification Other [1 ,� <br />71 Monitoring Well(s)# of .wells - Soil Boring(s) ant t=wgs F Geotechnical # or "" '.1" <br />I Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair JUN <br />New Pump x Pump Replacement I Pump Repair Raise Well Casing $ <br />WELL CONSTRUCTION N FAV/ AQUIN <br />Dnlhng Method J Mud Rotary Air Rotary J Auger IJ Cable Tool _. Push Point _ Other �A�T 'I 'O/y dPCG <br />Proposed Well Depth__ ft Excavation in diameter I i Open Bottom i I Gravel Pack.Gravel Size In didIR44f, ' <br />J Conductor Casing in diameter .i Conductor Casing Depth It <br />Well Casing Diameter in Thick ness'Gauge;ASTM Sched I I Steel Plastic I Stainless Steel Other <br />Grout Seal Depth ft _ Neat Cement (94 lb bag/!- 10 gat water) _ Sand Cement sack mfx;7 gal water <br />I Bentonite (20% solids) 1: Other <br />Grout Placernent Method _ Pumped J Free Fall Other L Retardant: Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Othcr <br />-1 Concrete Pedestal ]Dimensions Width ft Length ft Thick in _ Christy Box I Stove Pipe <br />PUMP X Submersible turbine Other HP 1 .5 Pump Set 63 ft Standing Water Level 83 ft <br />I HEREBY CERTIFY THAT 1 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 />J(3hiPUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 1209) 953-769UI64-coz— <br />SIGNED TITLE CEO DATE 6/18/2021 <br />/ / DEPARTMENT USE ONLY /� <br />Application Accepted By L � " Date V y % Area `% l Employee ID# /— �7 <br />Grout Inspection By ^ n_ Date SPECIAL Well Permit <br />Pump Inspection By 0%iTP ►— o�• �.Y`. Date " 1 WAIVER Received <br />Soil Boring Inspection By Date <br />COMMENTS <br />Constructed Well Depth <br />Ln <br />m <br />D <br />0 <br />z <br />m <br />y <br />PE <br />Codes <br />SC Received hec <br />Info -By Cas <br />Amount ate <br />Remitted <br />Permit/ <br />Service Re uest # <br />Invoice# <br />Well ID# <br />L <br />41� Z <br />r <br />r.:-1 43-06 8/1 V2019 ;�r'_LL 1PUN I' PERMI r <br />