Laserfiche WebLink
i„4.1 5 Gt. Iis-X 1 9L^ <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENNRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA96206-6232-(209)438-3429 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> L <br /> JOB ADDRESS 25960 S Lammers Rd Cn YZP/Tracy 95377 <br /> CR08SSTREET North of W.SChUIte Rd APN 240-060-06 PARCEL SIZE�tIZLAND USE APPUCATIONL <br /> OWNERNANE Brian Wise PHONE 209-835-0519 <br /> OMER ADDRESS 25700 S.Lammers Rd Qtt15TATE0P Tracy CA 95377 n ' <br /> CONTRACTOR Hennings Bros.Drilling Co.,Inc. PHONE 209-545-1185 I` nv <br /> CONTRACTORAooees6 1930 Ladd Rd cmisTATEmp Modesto CA 95356 �/r <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CRYISTATEZP <br /> LICENSE R C-67 C-61 I,D-09 C Other NUMBER 290813 E%PIRAnONDATE 05-31-18 <br /> GEOGRAPHICAL INFORMATION: COOrdinatesX Y Tamnshlp_ Range_ Seodm_ <br /> INTENDED USE F Domestic/Private C Imgaon/1gdcutiuml C IndusBlal J Water Quality Monitoring P Sad Sampling/Characterization <br /> J IPfdlfl.imnthnmrQ System <br /> ro... <br /> Type OF WORK N New Well Y Replacement Wei L Well ABeretion/ModiBration ❑Other <br /> ❑Monitoring Wells) Isar wells ❑Sod Boring(s) aor n.mN. U GeoleChnicel sof born, <br /> ❑Out-Of-Service Well C Out-OF-Service Well Renewal ❑Cross-Connection Repair r_ <br /> I Nev,pum i i Pump Replacement I i Pump Repair I Reise Well Casin V, <br /> WELLCONSTRUCTION <br /> Drilling Method k Mud Rotary ❑Alr Rotary 7 Allger ❑Cable Tool D.Push Paint ❑ Other <br /> Proposed Well Depth 300 ft E S Avation 12 in diameter C Open Sod. R Gravel PaddGmvel Size No.6 In diameter <br /> U Conductor Casing in diameter Y Conductor Casing Dept R Sand pack I <br /> Well Casing Diameter 6 in Thickness/Gauge/ASTM Srhed SOR96 U Steel a Plastic L Stainless Steel L Other <br /> Grout Seal Depth ton It Neat Cement(94/b bag/5-10 gat water) jSand Cement sack muA gal Wffier <br /> Q Bentonite(20%solids) I Omer <br /> Grout Placement Method B Pumped 3Free Fall - Other ❑Retardant I Acceleralor(name) <br /> Ell —T&L Installed By I i Driller x Pump Contractor i i Other <br /> Concrete Pedestal Dimensions:Widen ft Length 11Thick in I i Christy Box Stove Pipe <br /> pump Submelsiblao Turbine C Other HP Pump Set It Standing Water Level fl <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 /> BIGNED . MINIMUM 24 HOUR_ ,DVANC,E NTI REQUIRED FOR INSPECTIONS _ ) - /� <br /> JJ 9� `� P DATE <br /> oZIT <br /> 44 <br /> = <br /> t� <br /> Le-) <br /> o ae <br /> W Q-- ao u <br /> °egg <br /> i <br /> DEPARTMENT USE <br /> ��-O-/NNLLLYY <br /> Application Accepted By - Date-lri� / Areae Employee ID6� <br /> Grout Inspection By Data PECIAL Well Pefmit <br /> Pump Inspector,By Date WAIVER Received <br /> SDI]Boring Ins By . Date Co tracts Walt Da th R <br /> COMMENTS <br /> PE sC Received Checkw Amount Date PermW Invoke# Well IDM <br /> Codes Info Cash Remitted Service uest11 <br /> 91) j 7 S 3 15 11 (ZU6 Ip m l <br /> S 0 <br /> END 4309 wELLMUMPPERUIT <br /> NDIAS <br />