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7 <br />J <br />20506 WELL/PUMP PERMIT <br />-�AN JOAQ>JIN 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 />6599 E. FOPIANNO LN <br />Joe ADDRESS CITY/ZIP STOCKTON CA 95212 M <br />bmD <br />CROSS STREET SOLAR I RANCH RD/A,PN` 086-41-020 PARCEL 512E ��'�,qNp USE APPLICATION # C <br />�/il�(/ m <br />OWNER NAME _ A 7, T F K A M A T T c�.�-i: � PHONE 456-200 � <br />OWNER ADDRESS SAME CITYISTATEIZIP <br />CONTRACTOR Delta Pomp ST(1(-KTQN ARMATURF & MOTQR WORKS R"a- 209_466-96 5 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CiTYISTATE/ZIP <br />LICENSE 0 C-57 X C-61 0 D-09 0 Other NUMBER 724778 <br />EXPIRATION DATE Q <br />GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Township Range Section <br />INTENDED USE V,\Oomestic/Private 0 Irrigation/Agricult�-aTe� <br />ustrial 0 Water Quality Monitoring ❑'Soil Sampling/Characterization <br />C Public Water System <br />If different from Owner ame <br />ac ame or one um er <br />TYPE OF WORK C New Well 0 Replacement Well O Well Alteration/Modification ❑ Other <br />G Monitoring Wells) # of we((s Q SOI(Soring(s) # of borings # of bongs <br />0 Out -Of -Service Well ❑Geotechnical <br />O Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />❑ New Pum m Re lacemeni O Pum Re air ❑ Raise Well Casing <br />, i� <br />WELL CONSTRUCTION <br />Drilling Method 0 Mud Rotary ❑ Air Rotary 0 Auger ❑ Cable Tool 0 Push Point 0 Other �® <br />Proposed Welt De th '' � , " <br />P ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Sjer <br />0 Conductor Casing in diameter / Conductor Casing Depth ft O� *8t <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad /� E` /R QU/ C <br />0 Steel ❑ Plastic ❑ Stainless Steel tR r ON N OUPN <br />Grout Seat Depth ft 0 Neat Cement (94 Ib bag/5-10 gal water) 0 Sand Cement <br />0 Bentonite (20% solids) O Other sac p>RT ater <br />N/� <br />Grout Placement Method 0 Pumped ❑ Free Fall ❑ Other <br />0 Retardant !Accelerator (name) <br />PEDESTAL installed By ❑ Driller 0 Pump Contractor O Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick <br />n 0 Christy Box ❑ Stove Pipe <br />PUMP ubmersible0 Turbine C Other Hp <br />Pump Set it Standing Water Level ft <br />1 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 COMPENS <br />�MINIM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED --. TITLE CEO <br />DATE 6 1 2 7 1 0 1 8 <br />PUMP/WELL Is located <br />�; R• e.y,.i »�o-..., a �. +s 90„; y ,p�+;r,.<�ce <br />approx. 387.72 ft. under . �P. .� ��' I <br />the trees from the road. ' , <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />t�WAI- <br />7iO 4- -1 <br />1.14 <br />— _ ta8am0AFt�1LS. <br />MENT US <br />Date 1� <br />Date <br />Date <br />Date <br />area Employee ID# <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth _ <br />ft <br />EHD 43-06 <br />8!04/08 <br />WELL/PUMP PERMIT <br />