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19837 WELL/PUMP PERMIT PV/ <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />�N <br />JOB ADDRESS 2 41 3 5' 1 F • nr 4 CITY/ZIP STOCKTON 95215 <br />m <br />CROSS STREET STANLEY APN b �+y (J C� PARCEL SIZE 60 LAND USE APPLICATION # <br />OWNER NAME TONY CHIAPPE PHONEy 471-5791 <br />OWNER ADDRESS 5,41 9 S _ STANP..T,Y RD CITY/STATE/ZIP INGTON CA 95230 <br />CONTRACTOR Delta Pumv STC)rKTnN ARMATTIRF & MOTOR WO KS MM&. 209-466-962 <br />CONTRACTOR ADDRESS 646 S. California Street CITY1STATE/ZIP_ Stockton, CA 95203 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE 0 C-57 X C-61 0 D-09 ❑ Other NUMBER 724778 EXPIRATION DATE_ 08/j% <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Tnwnehin a.....e c, 1 -- <br />INTENDED USE 0 Domestic/Private Rkrigation/Agricultural ❑ Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />0 Public Water System <br />If different from Owner. a er SFStem Name Gontact Name or Phone Number <br />. .— YYtl,! u Replacement vven u wen Alteration/Modification 0 Other <br />O Monitoring Weil(s) # of wefts 0 Soff Borfn9() s # of borings 0 Geotechnical ff of borings <br />0 Out -Of -Service Well 0 Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />0 New Pump 0 PumD Reolacement n Pi mn Po—ir n m_;__ .n._u _. <br />Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool ❑ Push Point ❑ Other <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size in diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft <br />Weil Casing Diameter _ in Thickness/Gauge/ASTM Sched 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br />Grout Seat Depth ft 0 Neat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sack mix17 gal water <br />0 Bentonite (20% solids) 0 Other <br />Grout Placement Method 0 Pumped 0 Free Fall 0 Other. ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller ❑ Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick in 0 Christy Box ❑ Stove Pipe <br />PUMP 0 Submersible 1krbine 0 Other HP Pump Set A ft 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED �- "� --� �a-ar_.s.!—� K._ TITLE CEO DATE 3/20/2018 <br />EPARTMENT USE ONLY <br />Application Accepted By �'lJ�/� Date �' ��j -1 i <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil Boring Inspection By Date <br />COMMENTS <br />Area Employee ID#� <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />8/04108 WELL /PUMP PERMIT <br />D <br />0 <br />a <br />X <br />m <br />N <br />