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P'/ <br />19454 WELL/PUMP PERMIT <br />SAK JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205.6232 - (209) 468.3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 3606 E. GUERNSEY AVE CITY2IP _STOCKTON 95205 <br />CROSS STREET S- GARDEN APN 157-14-060 PARCEL StZE 0 . 8 1 LAND USE APPLICATfON # <br />OWNER NAME SALVADOR ALVERE Z 4 PHONE 916-912-1553(SON) <br />OWNER ADDRESS 2425 LUCI LLE AVE., CITY/STATEIZIP STOCKTON CA 95209 <br />CONTRACTOR Delta Pump-STncT<ToN ARMATj?gE & MOTOR WORKS 1146. 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />CITYISTATEIZIP <br />PHONE <br />LICENSE ❑ C-57 C-61 0 D-09 ❑ Other NUMBER 724778 EXPIRATION DATE -0 8 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE OKfiomestic/Private ❑ Irrigation/Agricultural ❑ Industrial 0 Water Quality Monitoring ❑ Soil Sam*hLq Characterization <br />❑ Public Water System <br />If different from Ovmer: Water System Narne —GonTacarra o i <br />TYPE OF WORK 0 New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br />Monitoring Wetf(s) # of wells E7 Soil Boring(s) # of borings <br />) O Geofechnrca <br />0 Out -Of -Service Well ❑ Out -Of -Service Well Renewal 0 Cross -Connection Repair <br />❑ New Pump ❑ Pump Replacement i $ump Repair 0 Raise Well Casino <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool 0 Push Point ❑ Other <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom 0 Gravel Pack/Gravel Size in diameter <br />d ng in diameter / Conductor Casing Depth ft II <br />Well P,E Thickness/Gauge/ASTM Sched O Steel ❑ Plastic ❑ Stainless Steel 0 Other <br />Grout ft 0 Neat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sack mixl7 gal water <br />i / olids) ❑ Other <br />�Grouxjlcement Method 0 Pumped ❑ Free Fall ❑ Other ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller ❑ Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑ Christy Box 0 Stove Pipe <br />PUMP bmersible❑ Turbine 0 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. 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 COMPENSAVOWLA9CS1 <br />SIGNED <br />NOTE: <br />FU v.P SET 2, S?ANIC!I`,IC <br />IS UNKNOWN UNTIL TF <br />M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />TITLE CEO DATE 5/11/2017 <br />T <br />I M <br />D <br />v <br />v <br />A <br />M <br />N <br />to <br />7Y <br />�;✓cap; <br />Application Accepted ByL 'V 1 10 'b <br />Date Area ---�� Employee ID#r� <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By <br />COMMENTS Qo _i vve ,A <br />PE I SC <br />,des Info <br />FyV C <br />—)qo <br />a <br />J <br />Date <br />Depth <br />T-"� � <br />Cash Remifted ate Service Ra'4 uest # In "iWell ID# <br />A9;0 2 ,�° �1��/,� SHOD '77'& <br />ft <br />EHD 43.06 <br />8/04108 WELL /PUMP PERMIT <br />