Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 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 /> (/f <br /> JOB ADDRESS 5607&5611 Pacific Avenue CITY/ZIP Stockton.CA m <br /> CROSS STREET APN/05F440- PARCEL SIZ LAND USE APPLICATION# <br /> m <br /> OWNER NAME HPC Stonecreek Investors PHONE 310-736-4989 <br /> OWNER ADDRESS 18321 Ventura Boulevard.Suite 980 CITYISTATE/ZIP Tarzana.CA 91356 <br /> CONTRACTOR Krazan&Associates.Inc. PHONE 5,59;48.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/LP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&ASSOCiates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/LP Clovis.California 93612 <br /> LICENSE VC-57 I C-61 i i D-09 I Other NUMBER 499908 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING:I 1 General Mineral/Coliform Bacteria(4391)I Dibramochloropropane(4392)I 1 Arsenic(4393) <br /> INTENDED USE I Domestic/Private i 1 Irrigation/Agricultural I i Industrial I Water Quality Monitoring i Sail Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well I Well Alteration/Modification I Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings �/Geotechnical 5 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair (10-50 Feet) <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary y/Auger Cable Tool Push Point Other <br /> Proposed Well Depth ft Excavation in diameter Open Bottom I I Gravel Pack/Gravel Size in diameter <br /> I Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched I Steel I Plastic I Stainless Steel I I Other <br /> Grout Seal Depth ft V Neat Cement(94 lb bag/5-10 gal water) I Sand Cement sack mixn gal water <br /> 1 Bentonite(20%solids) I Other <br /> Grout Placement Method Pumped Free Fall I Other I 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 HP Pump Set It Standing Water Level ft <br /> 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 /> MINIMUM 48 R DVA�NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SION TITLE Managing Engineer DATE 01/15/2020 <br /> R�yMF�rr <br /> CF�V�O <br /> qN <br /> N OqQ�,,202 <br /> /RON N OON <br /> HOFpgR��n <br /> A MENT SE ONLY <br /> Application Accepted By / DPI Area Employee ID#� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date /�� I WAIVER Received <br /> Soil Boring Inspection By t Date 2 5 G1J Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Amount ate PermtU Invoice# Well ID# <br /> Codes Info B ash Remi ed Service Request# <br /> ZZ17/ZZ WF`00401�5'9 <br /> EHD 43-06 r—sed 4/14118 WELL/PUMP PERMIT <br />