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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - Smcm-oN CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT 0 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 53/ Carolyn Westefn Blvd & Manthey ld crryizip Stockton, CA <br />CROSS STREET f Y7 41i41 ey ApN 164-220-210 PARCEL SIZE I • 0 1 LAND USE APPLICATION # <br />OWNER NAME Weston Ranch Partners i, LLC geveir- Group LL C PHONE <br />4040 MacArthur Blvd, Suite 250 OWNER ADDRESS CITY/STATE/ZIP Newport Beach, CA 92660 <br />Krazan & Associates, Inc CONTRACTOR <br />215W. Dakota Avenue CONTRACTOR ADDRESS CITY/STATE/ZIP Clovis, CA 93612 <br />SUBCONTRACTOR Krazan & Assoviates, Inc PHONE 559-348-2200 <br /> <br />215W. Dakota Avenue Clovis, CA 93612 <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE X C-57 CI C-61 L D-09 Li Other NUMBER 499908 <br /> <br />10.31.2022 <br />EXPIRATION DATE <br /> <br />559-348-2200 PHONE <br />1 WELL/PUMP PERMIT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE : Domestic/Private Li Irrigation/Agricultural Industrial :.. Water Quality Monitoring 1.1 Soil Sampling/Characterization <br />12 Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />El Well Alteration/Modification I Other <br />WELL CONSTRUCTION <br />ii <br /> <br />Drilling Method 1-• Mud Rotary Li Air Rotary 5 Auger c Cable Tool .1 Push Point I Other Atat . . .4) Proposed Well Depth 10 -5-0 ft Excavation in diameter _: Open Bottom Gravel Pack/Gravel ize 2 9 diamet <br />: Conductor Casing in diameter / Conductor Casing Depth ft `All'il v j r 2022 <br />Steef:1 <br />_ <br />&-1,,,2.64 Well Casing Diameter in Thickness/Gauge/ASTM Sched E Steel 7 Plastic : Stainless Q <br />Grout Seal Depth 10-5-0 ft X Neat Cement (94 lb bag/5-10 gal water) I Sand Cement . , <br />5 Bentonite (20% solids) II; Other <br />Grout Placement Method D Pumped L Free Fall L. Other ::::: Retardant / Accelerator (name) <br />PEDESTAL Installed By II Driller ri Pump Contractor EL Other <br /> <br />L:= Concrete Pedestal i Dimensions: Width ft Length <br />in 7 Christy Box EI Stove Pipe <br /> <br />ft Thick <br /> <br />PUMP Submersible].] Turbine 0 Other HP Pump Set ft Standing Water Level ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />MINIMIti:M 24 HOUR ADVANCE NtlfICE REQUIRED FOR iNspix."-rtoNs - PLEASE CALL (299) 953-7697 <br />DEPARTMENT USE ONLY <br />Date Sl?7/2? Area 51o( lac* Employee ID# A5 <br />Date J SPECIAL Well Permit <br />Date -1 WAIVER Received <br />Date Constructed Well Depth ft <br />iharl 3'0 feet or siovn cJe/r is <br />PE <br />Codes <br />SC <br />Info <br />Received <br />j3x <br />...V Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Well ID# <br />ii 37a PS-0 46 - 3537,2? ti°‘Ll 51231Z1 U)90DLY1531411 <br />, :SSMICIOV 31IS TYPE OF WORK El New Well n Replacement Well <br />Lli Monitoring Well(s) # of wells D Soil Boring(s) # of borings X Geotechnical 5 ' # of borings <br />E Out-Of-Service Well n Out-Of-Service Well Renewal i") Cross-Connection Repair (10-50 FA14 ht . <br />CI New Pump IL Pump Replacement 5 Pump Replir 5 Raise Well Casing <br />fr CL.147 4 7. <br />, 1 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring I2!pection By <br />COMMENTS eWtie. deeper <br />en Laun Wed <br />0110043-0404/0712022 Well Pump Permit Page I of 2