Laserfiche WebLink
PHONE <br />CROSS STREET Flood Rd APN10519001 PARCEL SIZE 64 -76 LAND USE APPLICATION # <br />OWNERNAME Vern Lucchetti/Yvette & Colette Lucchetti <br />OWNER ADDRESS 1380 Windrift Way crryisrATEmpWoodbridge , Ca 95258 <br />PH0NE 2 0 9-88 -3 554 <br />CITY/STATE/ZIP Linden CA 95236 <br />PHONE <br />CoNTRAcTOR ADDREsS P - O. Box 64 <br />SUBCONTRACTOR/CONSULTANT <br />CONTRACTOR Purviance Drillers, INC <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br />LICENSE k' C-57 Li C-61 El D-09 Other NUMBER <br />CITY/STATE/ZIP <br />377923 7/31/23 EXPIRATION DATE <br />Li CONTRACTOR Li SuBCoNTRAcTOR/CoNSULTANT BILLING PARTY: 1-2 OWNER <br />Water System Name Contact Name or Phone Number <br />PUMP Ti Submersibl Turbine 0 Other , HP \ea) Pump Set ft Standing Water Level ft <br />Area Lliqg Employee ID# ///// <br />rl SPECIAL Well Permit <br />Ft WAIVER Received <br />Constructed Well Depth ft <br />2e7 2—( WELL /PUMP PERMIT <br />WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STocKroN CA 95205-6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT WWW.Sigov.orgiehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPLING: I; General Mineral/Coliform Bacteria (4391) :1 Dibromochloropropane (4392) II Arsenic (4393) <br />TYPE OF WORK : New Well E Replacement Well I: Well Alteration/Modification I] Other <br />ii Monitoring Well(s) # of wells Li Soil Boring(s) # of borings [] Geotechnical <br />Ti Out-Of-Service Well E Out-Of-Service Well Renewal I 1 Cross-Connection Repair <br />Ti New Pump ii Pump Replacement )(Pump Repair fAeArld E. Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Ti Air Rotary Li Auger Li Cable Tool Li Push Point ri Other <br />Proposed Well Depth ft Excavation in diameter LI Open Bottom L1 Gravel Pack/Gravel Size in diameter <br />:1 Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched LI Steel E Plastic Ti Stainless Steel :1 Other <br />Grout Seal Depth ft ri Neat Cement (94 lb bag/5-10 gal water) L Sand Cement <br />Li Bentonite (20% solids) D Other <br />I HEREBY CERTIFY THAT I AVE 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 />-„DVANCE r‘ii2lis:CE :::ZiLE.i.iiViE.I.:: K.. - _ - .-, - PLEASE CALL (209) 9i-.74.137 <br /> TITLE cc-e—Ze_J'd-ti <br />/ <br />DATE <br />LI <br />2021 <br />Y/VIENT; RFCEIVCD2 <br />1 t:2 <br />NE' Ov <br />pa „IC <br />ENV <br />AOLEIN <br />RON <br />17 <br />knEN <br />MAN <br />AL' Tel br <br />DEPARTMENT USE ONLY <br />Aro VILIVf :SS31100V 3.US # of borings <br />sack mix/7 gal water <br />SIGNED <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By ,7I3 tit t,K; <br />Soil Boring Inspection By <br />COMMENTS <br />Date <br />PE <br />Codes <br />SC <br />Info <br />Rec lv d <br />A Y J \ <br />Checkill <br />/-Cash <br />Amount <br />Remitted . Date Permit/ <br />Service Request # Invoice # Well ID# <br />-4.- 7 11 1 iS 12-1 Mo0 9 3 <br />--. - - -- <br /> <br />, t x , , , _____ 1 i <br />Date <br />te <br />_.Date 11/1-7 2-,/1 <br />JOB ADDRESS 19640 E Flood Rd ordzi pLinden, CA 95236 <br />INTENDED USE L.; Domestic/Private %Irrigation/Agricultural Li Industrial [Ti Water Quality Monitoring [1 Soil Sampling/Characterization <br />L: Public Water Systdm <br />If different from Owner