Laserfiche WebLink
1 WELUPUMP PERMIT <br /> SIN JoAOUr1 COUNTY Ewwwo RENTAL HEALTH DEPARTiENT I$a EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> w <br /> Jos ADDRESS +/��{ crt �Yr <br /> CROSS STREETPN <br /> A �1 l +� PARCEL 3Qg 15� _LAND USE APALJCATION#n <br /> OWNER NAMrn L4 P>rOME 1Y— I <br /> EbKOWNER ADDRESS IV CrTY/8TATFIZP -7 ! Q <br /> CONTRACTOR PHOM/E�( 209-52 <br /> O'�� {51��j- 1��U <br /> CONTRACTOR ADDR£88 CrrdBTATEfZZrP M n(GAty '! C/ Iv <br /> 'T`•' <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRE88 CITY/BTATTlZIP <br /> LICENSE C57 ❑ C-61 ❑ D-09 ❑ Other NutreErt EX RATMIM DATE O 23 <br /> DostESTTc WELL SAds�t.wa:a General jAn&nVColiforTn Bacteria(4391)C Dibrumochbropropane(4392)0 Arsenic(4393) <br /> kTvmxp LIM ❑Domealiorrivste krigationlAgriciAural ❑ Industrial ❑Water Quaity Monitoring ❑SON SarTpkV/Charad w- <br /> ❑ Public wafer Syskvn ,�/I <br /> r aftent dam Owner. Webs 9yNsn Noma Cahn Name or Phone Nunber <br /> TYPE OF WORKNew Wel ❑ Replacement Well ❑ Well AftrIdOrYWOMCatiOn ❑ Other <br /> flu <br /> ❑ MonaNing Wel(s) #of weds ❑ SOY Boring(s) s ar borfngs ❑ Geotechnical 3 2022 <br /> ❑Out-04-SerAm wed ❑Out-0f-Service Well Renewal u Repair SA <br /> ❑ New ❑ Pum [i Pump R ❑ Raise Wel E J�AQU/N <br /> LTHbEp NTAL <br /> AR7- <br /> DdWnp MethodA(Mud Rotsry ❑Air Rotary ❑Auger Cable Tool ❑ Push POW ❑ Other <br /> Proposed Wall Depth ft Eracavation 2—in diameter ❑Open 13dLom Gravel Pack/Grgvol Size in tierriaisr <br /> ❑ Casing In dlameter / Conductor Casing Depth ft <br /> Well Casing Diameter Z in Ttsdatess/GeugaIASTM Stated 200 ❑ Steel �Pww�o Stainless Steel ❑ OtherGrout Beef Depth!� ft D Neat Cement(94 Ib baV5-f0 gal water) nt sack mod?gal water <br /> tK Bernwo;(20'16 Soils) ❑ Otlter <br /> Grout Pfaceenwi beetod Xumpad ❑ Free Fall ❑ Other D Retardant/Accelerator(name) <br /> Installed By ❑ Driller ❑ PUMP Contractor ❑ Other <br /> ❑Concrsts Pedestal❑Dirnerrslons:Width ft Length ft Thick <br /> rin ❑Christy Box D stow Pipe <br /> E ❑ Submersible❑Turbine o Other HP Pump Set ft Standing Water Level ft <br /> Plot Plan Requirei=ats: Attach a plot phu with the exact location of water well with respect to the following items: GPS <br /> Coordinates, property fuses, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br /> potential sources of contamination,servers or private disposal systems. Include dbts*m from two property lines. For Domestic, <br /> Agriculture,Indattrtrial well,provide loced"of any water wells or surface water within 200'radios of proposed well <br /> MINIMUM 24 HOUR.ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> D PA TYENT U E ONLY <br /> Application Accepted BY ` Data Area Employee ID# / <br /> Grout Inspection By Date k7ij2,Z ❑ PECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received <br /> SOY Boring inspection By <br /> Date Cornbucbrd WNI Depth n <br /> COMMENTS <br /> PE SC Recslwd t lratrlr:/ Amount Dole PwrIMtl Invoice# Well IDS <br /> Codas I Info 8V Ra nith d says <br /> SQr 2 <br /> r+s t orz w.0 i w,W vo ni <br /> moss ow7/= <br />