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1 <br />1754 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 9520$ -6232 (209) 468-3420 <br />IVVIV-ntI-UIVUACLt YtKMII WWW <br />I:APIKEb 1 YEAR FROM DATE ISSUED <br />Joe ADDRESS 2425 W. Lucile Ave. CITY/ZIP Stockton/95209 <br />CROSS STREET Don Ave. APN 080-20-002 PARCEL SIZE 0.84 LAND USE APPLICATION # <br />OWNER NAME Salvador Alvarez PHONE 650-676-7231 Javier -Son <br />OWNER ADDRESS SAME CITYISTATEIZIP <br />CONTRACTOR Delta Pump Co. _ PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. Califomia St. CITYISTATEMP Stockton/CA/95203 <br />SUBCONTRACTORICONSULTANT <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br />CITYISTATEIZIP <br />PHONE <br />LICENSE i C-57 XC -61 D-09 Other NUMBER 1055434 EXPIRATION DATE 7/3 112023 <br />BILLING PARTY: OWNER CONTRACTOR I I SUBCONTRACTORICONSULTANT <br />T <br />m <br />D <br />0 <br />A <br />m <br />H <br />DOMESTIC WELL SAMPLING: -IGeneral Mineral/Coliform Bacteria (4391) -1 Dibromochloropropane (4392) -1Arsenic (4393) <br />INTENDED USE XDomesticlPrivate -1 Irrigation;Agricultural - Industrial - Water Quality Monitoring F Soil Sampling/Characteri7atr3p <br />Public Water System_ • \A Y/I4,tr <br />f different from Owrei. Water System Narne Contact Name or Phone Number `� <br />TYPE OF WORK i New Well I Replacement Well Well Alteration,'Modification Other O <br />1 Monitoring Well(s) # of wells -Soil Boring # of borings s) (-' Geotechnical <br />0%A Of SOR)ice Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pump L Pump Replacement XPump Repair - Raise Well Casino frSAc� !CAn, 02 <br />DI Ill Ing Method -j Mud Rotary L Air Rotary 1 Auger U Cable Tool _ Push Point Other �FPgRTngC <br />Proposed Well Depth fl Excavation in diameter I I Open Bottom I Gravel Pack:Gravel Size In diameter <br />Conductor Casing In diameter / Conductor Casing Depth it <br />Well Casing Diameter _ in Thick ness'GaugeiASTM Sched I I Steel Plastic ! Stainless Steel Other <br />Grout Seal Depth ft _ Neat Cement (941b bag/5- 10 gal water) _ Sand Cement sack moo: i gal water <br />I Bentonite (20% solids) I' Other <br />Grout Placement Method Pumped -j Free Fall _ Othei Li Retardant 1 Accelerator (name) <br />PEDESTAL Installed By Driller PLimp Contractor Other <br />Concrete Pedestal -]Dimensions Width ft Length ft Thick in Christy Box I Stove Pipe <br />Eu- P X SUbrnersible_ Turbine Other HP—3 Pump Set 82 It Standing Water Level 25 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 <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />JUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-769' <br />SIGNED TITLECEO_. DATE 8/12/2021 <br />D E P A R T M EN T US E ONLY <br />Application Accepted By ��� Date <br />Grout Inspection By Date <br />Pump Inspection Date ?—,7-2e,?( <br />Soil Boring Inspection By Date <br />COMMENTS <br />Area 31gei LPiployee IL)# <br />I SPECIAL Well Permit <br />I WAIVER Received <br />Constructed Well Depth <br />PE Sc Received Check#/ Amount Dat Permit/ <br />Codes Info B as RemittedService- RQ uest # <br />Invoice # <br />Well ID# <br />43&:z <br />F-'-)4; -' -, v ;'eaLL!FUCVPPERMIT <br />