Laserfiche WebLink
WELL/PUMP PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-IHEFUNDABLE PERMIT CALL (ZU9) Ub3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />135 E WHITTIER AVE <br />CITY/ZIP <br />TRACY / 95376 <br />CROSS STREET <br />MAE AVE <br />IN FRONT OF 233-312-30 6710 5Q FT <br />APN PARCEL SIZE LAND USE APPLICATION #_ <br />OWNER NAME <br />PG&E <br />1 <br />PHONE 209-942-1421 <br />OWNER ADDRESS <br />4040 West Ln <br />CITY/STATE/ZIP <br />Stockton / CA / 95204 <br />CONTRACTOR <br />PG&E <br />PHONE <br />CONTRACTOR ADDRESS 535 S Center St <br />CITY/STATE/ZIP <br />Stockton / CA / 95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP { <br />LICENSE ■ C-57 C-61 D-09 Other NUMBER 339629 EXPIRATION DATE <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or 111ione um er <br />TYPE OF WORK ■ New Well Replacement Well Well Alteration/Modification ■ Other Anode Well <br />Monitoring Well(s) # of wells Soil Boring(s) # of borings Geotechnical # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />ivew rump rump rte lacemeni rump rte air rtaise vven basin <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth 200 ft Excavation 8° in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth It <br />Well Casing Diameter 2 in IThi ss/Gauge/ASTM Sched Steel ■ Plastic Stainless Steel Other <br />Grout Seal Depth. -4400ft Neat Cement (94 /b bag/5-10 gal water) ■ Sand Cement 10.3 sack mix/7 gal water <br />Bentonite (20% soli 1W Other <br />Grout Placement Method ■ Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine ■ Other___VL_ A HP Pump Set 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 />WORKERS COMPENSATION LAWS. <br />MINI"M 2 OUjANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Associate Distribution Engineer DATE 10/03/2016 <br />N <br />�. 0L. -I it its Q'"` !''i I E WHITTIER AVE <br />)EPP q] I <br />a aw"A I W <br />VA being mpleted or inSPI26 d <br />by Division <br />L <br />Application Accepted 89 <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />cn <br />M <br />tit­� <br />Zsw <br />)�t <br />•� DW LOCATION v N <br />10' Cr <br />AvY <br />w ogQ <br />'Z <br />LEGEND <br />Uj PROPERTY LINE <br />EDGE OF PAVEMENT <br />RTMENfT[� SE N Y <br />.4 Date t �/ <br />Date <br />Date <br />Date <br />Area Employee ID#UL-0� <br />PECIAL eil Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Well ID# <br />1 <br />0� 3 <br />Z� •� <br />�o S <br />EHD 43-06 WELL iPUMP PERMIT <br />4/30/12 <br />