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n <br />20'148 WELL/PUMP PERMIT <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 />Jos ADDRESS 1 489 W_ ijunTNF RIl CITY/ZIP 9T-0GKT N CA 95296 <br />CROSS STREET 1NO CROSS S TR . F.T APN1 _91 41 R — o Q_2 PARCEL SIZE -42 7 . BAD USE APPLICATION # <br />OWNER NAME MARK CERR I j C L R zPHONE4 8 2- 0 7 0 0 <br />OWNERADDRESS 4719 QUAIL LAKE DR. SUITE # G CITYISTATEIZIP_STOCKTON ra as207 <br />CONTRACTOR Delta Pump-gTCI('KTON ARMATURE & MOTOR WORKS fiOfih- 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATFJZIP_ Stockton, CA 95203 <br />BCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS <br />LICENSE ❑ C-57 X C-61 <br />CITY/STATE/ZIP <br />❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/M <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Townshin P.— <br />v <br />INTENDED USE X1)Qomestic/Private a Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br />❑ Public Water System <br />If different from Owner: a er ys em ame Gontact Name or Phone Number <br />� ivcw Yve❑ a mepiacement vven ❑ well Alteration/Modification D Other <br />? Monitoring Well(s) # of weffS O Sof( Sorin s >F of borings <br />9l) ❑ Geotechnical <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair ce,,O <br />❑ New Pump 0 Pump Replacement @,RLjmp Repair ❑ Raise Well CasingPIED <br />WELL CONSTRUCTION AIJ� 1 <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger 0 Cable Tool ❑ Push Point ❑ Other ����8 <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/GraveS i" Q�1,�_ !fV (clia91eter <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft SALT '�Q►v�EN"�1yr T' <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched ❑ Steel D Plastic ❑ Stainless Steel ❑ Other EPARI7NCNT <br />Grout Seal Depth - ft ❑ Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack mixf7 gal water <br />0 Bentonite (20% solids) 0 Other <br />Grout Placement Method ❑ Pumped ❑ Free Fall D 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 D Christy Box C Stove Piipe <br />PUMP ❑ Submersible❑ Turbine ❑ Other T-Rrp HP—===j Pump Set ft Standing Water Level I <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 CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENS ION LAWS. <br />MINIM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED ^ TITLE CEO DATE 3 2 $n12 C) 1 8 <br />PUMP -')t T & STANDING VV rrn i rvri <br />IS UNKNOWN UNTIL THE JC <br />DEPARTMENT USE ONLY <br />Application Accepted By Ll— Date 9 � -' J <br />Grout Inspection By Date _ <br />Pump Inspection By 1 Date <br />Soil Boring Inspection By Date <br />COMMENTS <br />PE SC I Received ec Amount <br />Codes Info B Remitted <br />40,;-oL&ISI 3d7�� 77 <br />Date <br />-r or' <br />Area ) Employee ID# h M e <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth <br />iJ2wr-9cx>> <br /># I Invoice # I Well ID# <br />ft <br />EHD 43.05 <br />8/04/08 WELL /PUMP PERMIT <br />T <br />1 <br />D <br />0 <br />m <br />m <br />