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?N <br />✓� <br />WELL/PUMP PERMIT P <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADI/Ess Deborah Circle 1 8 v✓atn�o r) cDh VG CITVIZIP Escalon, California 1 53� <br />CROSS STREET Swanson Drive APN PARCEL SIZE LAND USE APPLICATION # <br />OWNER NAME Windward Pacific Builders, Inc. U LLCM9.312.6564 <br />OWNER ADDRESS PO Box 576489 // 17jo C_(/#4 L&, Clry/STATEIZIP Modesto, California 95357 <br />CONTRACTOR Krazan & Associates, Inc. LQO PHONE 559.348.2200 <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue CITYISTATEIZIP Clovis, CA 93612 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS <br />LICENSE J C-57 <br />C-61 D-09 Other <br />CITY/STATEIZIP <br />NUMBER 499908 EXPIRATION DATE 10/31/2018 <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 5ystern Nerne CrIntad N.— or Phone Nurnter <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br />MonitoringWell(s) # of wells Soil Bonn s # or bor <br />() g() ngo JGeotechnical 6 of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair —10 ,p f, <br />Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth It Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter 4% in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth ft /Neat Cement (94 Ib bagi5-10 gal water) Sand Cement sack mix17 gal water <br />Bentonite (20% solids) 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 It Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP Pump Set It 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 />SMI AUM 2 OUIR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-76$7 <br />s–* Managing Engineer 5 2 �S <br />SIGNED y c TITLE DATE _ <br />PA MENT U�Y <br />Application Accepted By Date <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil Boring Inspection By Date :WL , <br />COMMENTS <br />'EIVECi <br />D 3 2011 <br />oi V <br />Area Employee ID#� <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />EH D 43-00 WELL /PUMP PERMIT <br />4/30/12 <br />