Laserfiche WebLink
I <br /> WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY ENVOMMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468.3420 <br /> �J p NON-REFUNDABLE PERMIT www.s 09 V.Or9/ehd _ EXPIRES 1 YEAR FROM DATE ISSUED <br /> I O I Joe ADDRESSS.State Route 99 W.Frontage Road clnrt,P Stockton/95206 __ _ m <br /> D <br /> CROSS STREET Transworld Drive APN 179-270-110 PARCEL SIZE 3/ LAND USE APPLICATION# s <br /> m <br /> OWNER NAME Oswaldo Granados Ordaz PHONE 650.218.4215 H <br /> OWNER ADDRESS 1828 Stageline Circle CITYISTATEIZIP Rocklin,CA 95765 <br /> CONTRACTOR V&W Drilling-Contact:Karli Stroing PHONE 209.981.7755 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive Cmr/STATERp Gait,CA 95632 <br /> SUBCONTRACTO ONSULT Condor Earth-Contact:Ron Skaggs,PE,GE 312295 ptgNE 209.938.1040 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 188 Frank West Circle,Shite I CrrY1sTATE" Stockton,CA 95206 <br /> I <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 ExPIRATION DATE 04/30/2022 <br /> BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE DomesticlPrivate Irrigation/Agricultural Industrial Water Quality Monitoring t Soil 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 Well Alteration/Modificalion Other <br /> Monitoring Well(s) It of wells Soil Borings) #e.bon'9s X Geotechnical 2 _#of bongs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement_ Pump Repair Raise Well Casing __ _ <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Ar Rotary Auger Cable Tool Push Point Other <br /> (Proposed Well Depth 10 to 20 It Excavation 4 1'2 in diameter Open Bottom Gravel Pack/Gravel Size in diameter'j <br /> Conductor Casing in diameter I Conductor Casing Depth ft <br /> i <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth full depth It X Neat Cement(94 lb bag/5-f0 gal wafer) Sand Cement _-sack mix17 gal water <br /> Bentonite(20%Solids) Other <br /> Grout Placement Method Pumped Free Fall X Other Tremie 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 /> MP Submersible Turbine Other HP Pump Sol ft Standing Water Level __II <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 OUR EQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED t TITLE Project Coordinator DATE 03/11/21 <br /> Ec MFN <br /> ZA <br /> F gRTTq�NTY <br /> MFNr <br /> DEPARTMENT USE ONLY <br /> 1 L <br /> Application Accepted By �L L Date .i Area Iy S n�r`{'' Employee ID# D� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By -Date LZ Constructed Well Depth R <br /> COMMENTS <br /> PE Sc Realved Check#/ Amount Da Permit/ Invoice N Well ID# <br /> Codes info Cash Remitted Se 'c st a <br /> LI 1 <br /> END43-08 6111/2019 • /�l�Q'D/� -- WELL(PUMP PERMIT <br />