Laserfiche WebLink
CM/STATE/ZIP Clovis, California 93612 SUBCONTRACTOR ADDRESS 215 W Dakota Avenue <br />EXPIRATION DATE 10 31 2018 LICENSE VC-57 C-61 D-09 Other NUMBER 499908 <br />ft <br />mployee ID#48AV <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE STOCKTON CA 95205 - (209) 468-3420 <br />DomEsTic WELL SAMPUNG: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />If different from Owner <br />Iff.aL4DE _ Domestic./Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />D Public Water System <br /> <br />Water System Name Contact Name or Phone Number <br />Pump Repair Raise Well Casing <br />Concrete Pedestal !iDlmensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />ft Pump Set ft Standing Water Level HP PUMP (1 Submersible Turbine Other <br />TYpE OF NZ 0 New Well Replacement Well <br />Monitoring Well(s) # of wells <br />n Out-Of-Service Well <br />New Pump Pump Replacement <br />Well AJteration/Modification <br />Soil Boring(s) <br />Other <br />II of borings Geotechnical 2 Cot bonngs <br />Out-Of-Service Well Renewal Cross-Connection Repair (1050 Feel, <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary J Auger Cable Tool Push Point 17 Other <br />Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in Tpickness/Gauge/ASTM Sched El Steel 0 Plastic Stainless Steel Other <br />Grout Seal Depth( a -- b ft Neat Cement (94 lb bag/5-10 gal water) Sand Cement <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped Free Fall otter7-74t6.-, Retardant / Accelerator (name) <br />sack mix/7 gal water <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 />MIN MU 48 HO D k.._N_CE-NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 95.767 <br />Sinxi613. 2 TITLE Managing Engineer DATE 7 1 7110 <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info BA, <br />ReceivedAV) <br />as <br />Amount <br />Remitted Date Permit/ <br />Service Repruest 8 Invoic <br />4)72-190 ae- &-3RSIO 4if-t•C 1-2.4-1‘Z V'JC)01)") '1 <br />pERmi <br />)&79 <br />EXPIRE :SS3210:10V 311S 64*Y/DlIc7 ih.s&_ 94.6D <br />EHD 43-06 revised 4 /14/18 &Leek= L/37. r0 WELL /PUMP PERMIT <br />PA MENT T <br /> Date <br />Date <br />Date <br />Date <br />0 <br />Area <br />NON-REFUNDABLE PERMIT CALL1209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />(f2/d . ee/1-5'&- <br />217-35-038 APN PARCEL SIZE d.Z.- LAND USE APPLICATION <br /> PHONE <br />CITWSTATETZIP Saratoga, California 95070 <br />PHONE 559.348.2200 <br />JOB ADDRESS <br />CROSS STREET Louise Avenue /1087 Hacienda Avenue <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS 215W Dakota Avenue <br />Krazan F. Associates, Inc SUBCONTRACTOR <br />CITY/STATE/ZIP Clovis, California 93612 <br />PHONE 559 348 2200 <br />CITY/Zip Manteca. California <br />Balaji Bashyam <br />20766 Norada Cr <br />Krazan & Associates, Inc <br />111 4 'p 2018 <br />cNV/,`MA/: COLN, i FAit i r <br />R 7-m /\/7- <br />\it A <br />PA v <br /> /C6:1,11541t. Et) <br />A <br />Is•