SR0036821 - Laserfiche WebLink

Home Browse Search

7-- WELL 1 PUMP PERMIT H DEPARTMENT 304 E WEBER AVE 3"°FL-STOCKTON CA 95202 - (209)468-3420 SAN 30AQUlN COUNTY ENVIRONMENTAL FIEALT 1 NON-REFUNDABLE PERMIT CALL(709)953-7697 FOR INSPECTIONS EXPIRES FROM DATE ISSUED CiTY1ZIP Lathrop, Ca a 1 4675 Lathrop Rd JOB ADDRESS �j�7 ` LNr""'�" ®_f APN [ ! C ZO I Z PARCEL SIZE r� F CROSS STREET P�� S ` s + L- Lr � PHONE OWNER NAME South Sari Jail' UlII rr I 245U W. Yosemite CITY/STATE/ZIP Manteca CA 95337 OWNER ADDRESS _ PHONE,�Q — CONTRACTOR Purviance Drillers Inc. . BOX 6 CITYISTATEIZlp Linden Ca 95236 . CONTRACTOR ADDRESS PHONE SUBCONTRACTOR +4 ^ CITY/STATE/ZIP SUBCONTRACTOR ADDRESS 377924 EXPIRATION DATE 131 105 LICENSE C-57 ❑"C 6l ❑D-09 0 Other NUMBER V Township Range Section I GEOGRAPHICAL INFORIIMATION'. Coordinates X ❑SGoiI.Sa plingl r tenzatio E3Eln Domestic/Private lrrigation/Agricultural ❑Industrial ❑y�ater Q 1'I I, INTENDED USE r 9 3 c xf 0 Public Water System to am or o e um O ater ystem eme k' If different from wner: `Ilray h t�lh ` 4� T { 4 ' r of borings f TYPE OF WORK 13 New Well ❑Replacement Wei! " C]Well Alteration/Modification n ,erofffbf"onnbs Q Geo echnical number of wells ❑Soil Borings} #' �]�?�s El Monitoring Well(s) V 4 b td WeQ e�yy p Out Of Service Well Outggr5t 'Nmt Rre a ER-Well Destruction ; } ir) ` C' i ❑New Pum ❑Pum Re lacement El Re air WELL CONSTRUCTION ❑ALL Auger ❑Cable Tool ❑Push Point 12 Other Drilling Method ❑Mud Rotary ❑Air Rotary g Proposed Well Depth ft Excavatian� in diameter ❑Open Bottom ❑Gravel Pack!Gravel Size in diameter ❑Conductor Casing in diameter 1 Conductor Casing Depth tt ❑Steel ❑Plastic ❑Stainless Steel ❑Other Weil Casing Diameter in Thickness/GaugeIASTM Sched ❑Sand Cement suck mix 17 gal water Grout Seal Depth ft ❑Neat Cement(94 lb bug/5-10 gal water) 13 El on File ❑Specs Submitted ❑Bentonite(20%solids) ❑Manufacturer Spec%solids % Name I ❑Retardant/Accelerator(name) Grout Placement Method ❑Pumped ❑Free Fall ❑Other � ❑Driller [2 Pump Contractor ❑Other PEDESTAL Instelled� ❑Concrete Pedestal Dimensions. Width ft Length ft Thick in El Christy Box ❑Stove Pipe ft Pump ❑Submersible ❑Turbine' ' 13 Other a HP Pump Set ft Standing Water Level WELL DESTRUCTION ❑Open Bottom - ❑Gravgl Pack ❑Uncased ❑Other u ftto r in ID h ft De to b erf alio Mater at nt(9 ag -10 gal ter) ❑ nd Cement sac ix/7 g a Bent a ets to(20 s s} M ufactur pec%solid Na r'l"n ile Su itted P[ ment Meth m Fr Fall ❑Other omplet it us om p ft below g C plete to Exis g S face Pa I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL + WORKERS COMPENSATN L S. IN UM 2 R VANCE NOTICE REQUIRED FOR INSPECTIONS—PLEASE CALL(209053-7697 SIGNED + TITLE Corporate Secretary DATE 2/2/04 f: I • r a� s �n DEPARTMENT USENLV, Application Accepted By �.--�-- Date �— l Q Area > Employee ID# l S� Grout Inspection By + Date ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received e Destruction Inspection By Date Constructed Well Depth ft COMMENTS �`{ ,_� nor Cae �rr ove- —fzvo a� C¢ce.^e 4� tue w� a t g,4 PE SC Received Check#/ Amount Permit! Codes Info B Remitted Date Service Request# Invoice# Well iD# 143--73 !fo I `%c3 15-0•Ute O (� EHD 43-02-006 _ MASTER WATER WELL PERMIT 12/6/2002