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TYPE OF WORK liNew Well Replacement Well <br />Monitoring Well(s) # of wells <br />Out-Of-Service Well <br />New Pump Pump Replacement <br />Well Alteration/Modification VOther cathodic protection well construction <br />Soil Boring(s) #51 borings Geotechnical # of borings <br />Out-Of-Service Well Renewal Cross-Connection Repair <br />Pump Repair Raise Well Casino <br />S,4 3e 4±7-0 <br />DEPARTMENT USE ONLY <br />eIf 1.2313o-77 <br />WELL /PUMP PERMIT EHD 43-06 6/1112019 <br />Retardant / Accelerator (name) Other <br />Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: VVidth ft Length ft Thick in Christy Box Stove Pipe <br />PEDESTAL <br />ft Pump Set ft Standing Water Level HP PUMP Submersible Turbine Other <br />WELL CONSTRUCTION <br />Drilling Method VMud Rotary Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth 61 ft Excavation 8" in diameter Open Bottom VGravel Pack/Gravel Size in diameter <br /> <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in ThicknesyGauge/ASTM Sched Steel Plastic Stainless Steel %/Other No Casing <br />Grout Seal .Dippth_ 20 FT ft y Neat Cement (94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />V Bentonite (20% solids) Other 23'-3'NEAT CEMENT <br />Grout Placement Method Pumped Free Fall <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 />MINIMUM 48 HOUR ADVitys,tE2.40TICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />/hre-or TITLE Construction Manager DATE 04/02/2021 SIGNED <br />Area 3 9 Employee Ila# fag <br />SPECIAL Well Permit <br />WAIVER Received <br />Soil Boring Ins ection,By Date Constructed Well Depth ft <br />C5IMMENTS -Ad encroAcit men+ ppf PA1 rriivivt &inns./ 1/4 ;:t Wepl4 riesi <br />Neer <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Date q <br />Date <br />Date <br />PE <br />Codes <br />SC <br />Info <br />Received di_ Check#/ Amount <br />Remitted ate , i <br />Permit/ Invoice # Well ID# <br />14371 /Pif V; 6/4._- # 32S <br />ash - 14211A , Service li <br />L114. <br />ggpest # WPOO 3 <br />CI) <br />CITY/STATE/ZIP Stockton, CA 95202 <br />707-741-1761 PHONE <br />CITY/STATE/ZIP Benicia, CA 94510 <br />PHONE 510-509-4993 C SUBCONTRACTOR/CONSULTANT orrpro Companies Inc.., <br />BILLING PARTY: OWNER <br />LICENSE 4-57 C-61 0-09 Other <br />CONTRACTOR <br />NON-REFUNDABLE PERMIT <br />JOB ADORE W McDonald Rd & S Holt Rd Intersection (GPS: 37,955550, -121A25222k CITY/ZIP <br />CROSS STREET S <br />HOLT RD APN 1310 C 006 (Pe41)3ARCEL SIZE <br />OWNER NAME <br />LAND USE APPLICATION # <br />PHONE <br />www.s ov or ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />Stockton, CA 95206 <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />Underground construction Co. <br />5145 Industrial Way <br />SUBCONTRACTOR/CONSULTANT ADDRESS 2625c Barrington Court CITY/STATE/ZIP Hayward Ca 94545 <br />NUMBER 764878 EXPIRATION DATE 06/30/2021 <br />WSUBCONTRACTOR/CONSULTANT <br />City of Stockton <br />City Hall, 425 N , El Dorado St