WP2501308 - Laserfiche WebLink

Home Browse Search

. I 4 E p LI,EO WELL/PUMP PERMIT SAN JOAQUIN CO PARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED I U r�r��P f5 L�� M JOB ADDRESS / /1 �1J �1 I CITY/ZIP L �=1 CROSS STREET l U f 1 —lY V/� 1VJ�' APN L1—�� I.N Z PARCEL SIZE Z'3 LAND USE APPLICATION# A OWNER NAME 7 1Zt� /l� / t��/►'► V 1 I{ (�1t I'I L�CJ] PHONE OWNER ADDRESS I �L /\(� GJC 1��.�.f\,� Y �— CITY/STATE/ZIP Ole"B fC CONTRACTOR MASELLIS DRILLING, INC. PHONE 209-522-1928 C� G CONTRACTOR ADDRESS 119 ALBERS RD. CITYISTATE/ZIP MODESTO,CA 95357 SUBCONTRACTOR PHONE (� SUBCONTRACTOR ADDRESS CITY/STATE/ZIP V LICENSE X C-57 C-61 D-09 0 Other NUMBER 668622 EXPIRATION DATE 04/30/2023 DOMESTIC WELL SAMPUNG:xGeneral Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) `. INTENDED USE Domestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring 0 Soil Sampling/Characterization ❑ Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK ANew Well D Replacement Well ❑ Well Afteration/Modification Other ❑ Monitoring Well(s) #of wells [I Soil Bohng(s) #of borings ❑ Geotechnical or borings ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal 0 Cross-Connection Repair ❑ New Pump ❑ Pump Replacement. Li Pump Repair 0 Raise Well Casing WELL CONSTRUCTION Drilling Method X Mud Rota ❑ Air Rotary P.Auger " Cable Tool Push Point ❑ Other Proposed Well Depth _,) It Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter t. Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter, t t in Thickness/Gauge/ASTM Sched 2—Yn- �i Steel XPlastic Stainless Steel 0 Other Grout Seal Depth 10T ft 0 Neat Cement(94 Ib bagi5-10 gat water) ElSand Cement sack mix/7 gal waterCIO Bentonite(20%solids) [IOther Grout Placement ethod Pumped D Free Fall ❑ Other ❑ Retardant/Accelerator(name) PEDESTAL Installed By 0 Driller ; Pump Contractor 1 Other L_ Concrete Pedestal❑Dimensions:Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe PUMP ❑ SubmersibleD Turbine ; Other HP Pump Set ft Standing Water Level ft Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture,Industrial well,provide location of any water wells or surface water within 200'radius of proposed well. �IINI'NL).%1 Z4 II01!R kD% k,c vOiIi t:Ki 1,1t 11,I:U DEPARTMENT USE ONLY �/ c Application Accepted By A&76b- Date h��0�2s Area / 4 Employee ID# �)T Grout Inspection By Date I L SPECIAL Well Permit Pump Inspection By Date WAIVER Received Soil Boring Inspection By Date C nstruc t4 Well Depth, _I ft 1100 COMMENTS /1/�7 S S `"�_ %�e I I cW1 G VAV)K ------.-- PE SC Received Check#/ Amount Date Permit/ Invo' WellID# Codes Info B Cash Remitted Service Request# 0C �P J� 5 O EIID043.0604/07f2O22 �! ^ , I—l�/1 [/ Pni�e I,r_ Well;Pump PcrmA l/It Q ✓ '�V/ Uploaded into Accela