Laserfiche WebLink
-1-till 16 Il <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE P MIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 5474 NILE clrytzlP MANTECA, 95337 m <br /> D <br /> S UNION RDb° may, <br /> CROSS STREET APN �� PARCEL SIZE� LAND t19@ APPLICATION# M <br /> m <br /> OwNIRNAME ARNOLD ROTHI IN JR PHONE 209.823.9961 <br /> OwNERADDRESS 5474 NILE RD _ CITYlSTATEIZIP MANTECA, CA 95337 <br /> CONTRACTOR N &S_IRRIGATION INC PHONE 209.5.3456 <br /> CONTRACTORADDRESs 215 W. MAIN STREET crryisTATEIZIP RIPON, CA. 95366 _ <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATIll <br /> s <br /> LICENSE !:C-57 C-61 D-09 XOther C10 NUMBER 662732 EXPIRATION DATE 01115 eo <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> rlPrivate JINTENDED USE DomestiI ImigationlAgricultural I Industrial 'I Water Quality Monitoring Soil SamplingfChar-acterizationPublic Water System <br /> It di ferenl from Owner: a er YSIern Nanno Uontact Name or no um r <br /> TYPE OF WORK New Well Replacement Well Well AterationlModification 1 1 Other <br /> Monitoring Well;s} #of wells Soil Borings} a of bonrgs !Geotechnical rf of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal I i Cross-Connection Repair <br /> New Pump X Pump Replacement Pump Repair Raise Weli Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Ar Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth ft Excavation in diameter 1 Open Bottom -Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diametel in Th4cknesslGaugelASTM Sched Steel I Plastic i Stainless Steel !:Other <br /> Grout Seal Depth ft Neat Cement(94 lb bagr5-10 gal water) i Sand Cement sack m xf7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method :i Pumped , Free Fall Other 1 Retardant I Accelerator{name) <br /> PEDESTAL Installed By _ Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions.Wdth ft Length ft Thick in Christy Box i Stove Pipe <br /> PUMP XSutmersibie Turbine Other HPC_ Pump Set_ 4f ft Standing Water Level ft <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 /> WORK OMPE ATION LA S. <br /> M U H U DV,{4N�YI NOTICE REQUIRED FOR <br /> �{INSPECTIONS-PLEASE CALL(209)`953-+7697 1 E p <br /> SIGNED- ,1I r97 TITLE.. rwa f' �M DATE <br /> N <br /> s E AUL1fi <br /> 1NIV1RONMENTAL HEA! <br /> PERMITrSERKES <br /> RE EMIyE p <br /> UZ 8 20 <br /> ems 44UJb' <br /> EE"7q NilFiy� QTY <br /> t=p�RrkfiVr <br /> DEPARTMENT USE ONLY 4 .,���y <br /> Application Accepted By Date ' i u Area V Employee ID# 1a__"7�" <br /> Grout Inspection By bate I.'. SPECIAL Well Permit <br /> Pump Inspection By Date L WAIVER Received <br /> Soil Boring Inspection By _ Date Constructed Well Depth It <br /> COMMENTS <br /> PE SC I Received Chec AmountDate Pennrt Invoice# Well Ill// <br /> Codes Into By— Remitted �I Service Re nest# <br /> EHD 43-06 WELL(PUMP PERMIT <br /> 4!30112 <br />