Laserfiche WebLink
WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />lJoBADDRESS 26300 E St Rt Hwy 26 <br />CITYmPLinden, CA 95236 <br />CROSS STREET Shelly APN <br />OWNER NAME Tom McGurk Farming <br />OWNERADDRESS _P.O. BOX 83 <br />06719014 <br />m 7 onk <br />CONTRACTOR Purviance Drillers, Inc <br />CONTRACTOR ADDRESSO BOX 64 <br />CITY/5rgrE/Zlp <br />SUBCONTRACTOR n/a <br />SUBCONTRACTOR ADDRESS <br />PARCEL SIZE a OS LAND USE APPLICATION # <br />r+cP► LGL /ruJ .Z`(— �(3✓ <br />PHONE <br />CITYI3TATE/Zfp Stockton, CA 95201 <br />LICENSE }:C-57 ❑ C-61 ❑ D-09 ❑ Other <br />CITY/STATE/ZIP <br />NUMBER 377923 <br />. PHONE209-887-3554 <br />Linden, CA 95236 <br />PHONE <br />EXPIRATION DATE <br />DOMESTIC WELLSAMPUNG: - General Mineral/Coliform Bacteria (4391) _- Dibromochloropropane (4392) Arsenic(4393) <br />INTENDED USE ❑ Domestic/Private Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑Soil Sampling/Characterization <br />❑ Public Water S st m <br />TYPE OF WORK <br />J <br />If different from Owner Water System Name <br />Name or Phone <br />❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification <br />❑ Other <br />❑ Monitoring Well(s) # of wells ❑ Soil Borings) # of borings # <br />❑Geotechnical <br />❑ Out -Of -Service Well I ,� <br />❑out -Of -Service Weil Renewal ❑Cross -Connection Repair ,t <br />❑ New Pump ❑ Pump Replacement -•5,Pump Repair ❑Raise Well Casino �'y/ 7 i <br />V <br />tnIntiI, <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point ❑ Other // FNV/R QC//N <br />Proposed Well Depth ft Excavation in diameter 7 Open Bottom ❑ Gravel Pack/Gravel Size <br />❑ Conductor Casing in diameter / Conductor Casing Depth �� �a iter <br />Well Casing Diameter in Thidmess/Gauge/ASTM Sched ❑ Steel ❑ Plastic 0 Stainless Steel ❑ Other <br />Grout Seal Depth It ❑ Neat Cement (94 lb bag/5-90 gal watel) 0 Sand Cement <br />❑ Bentonite (20% solids) ❑ Other sack mix/7 gal water <br />Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other <br />❑ Retardant /Accelerator (name) <br />PcnCCTet <br />_s U ut finer u rump contractor ❑ Other <br />In <br />❑ Concrete Pedestal ❑Dimensions: Width ft Length ft Thick <br />❑ Christy Box ❑ Stove Pipe <br />PUMP ❑ Submersible)(Turbine ❑ Other HP I <br />Pump Set It Standing Water <br />Plot Plan Requirements: Level _ � ft <br />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 weR. <br />DEPARTMENT USE ONLY <br />Application Accepted By ;Z'L✓L Date S o?3 2a <br />Grout Inspection By Date <br />Pum Ins ' <br />Pump Inspection By N Date <br />Soil <br />� LZ <br />Soil Boring Inspection By o Date <br />Area �q Employee ID#Ins <br />❑ SPECIAL Well Pennit <br />❑ WAIVER Received <br />Constructed Well Depth ft <br />7Wq3 J�� well/RsmpPetmit <br />