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•20367 <br /> WELL/PUMP PERMIT f" Z" <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 T YEAR FROM DATE ISSUED <br /> JOB ADDRESS 800 E. MADRUGA RD. CITY/ZIP LATHROPl A 9 5 3 3 0 gmpm <br /> CROSS STREET [JTHFR MT T T FR R n APN 2 41 -CL 013. PARCEL SIZE 1 5 9 . 9 4ND USE APPLICATION# C <br /> OWNER NAME TONY NOCETI _I,� `- / /� �(�� ff PHONE4482-6969 <br /> OWNER ADDRESS P.O, BOX 4 0 FR FNC'H CAMP/3/�l 1M Cil el�'�� # !r virvc C0 q zlol2- <br /> CITY/STATE/Zip FR FN H CAMP ("A 95231 <br /> CONTRACTOR Delta Pump STn(-xTnN ARMATUgF & MOTOR WORKS ff►36Q. 209-466-962 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 0 C-57 X C-61 ❑ D-09 0 Other NUMBER 724778 EXPIRATION DATE_ 08/f% <br /> 10 p <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE ❑ Domestic/Private kvklrrigation/Agricultural 0 Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> C Public Water System <br /> If different from Owner: Water Systern Name ac ame or one u <br /> TYPE OF WORK C New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br /> 0 Monitoring Wells) #or Wetfs O Soif Boring(s) #of borings <br /> ❑ Geotechnical <br /> Out-Of-Service Well 0 Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> C New Pump 0 Pump Replacement kCXPump Repair 0 Raise Well Casin <br /> WELL CONSTRUCTION <br /> JOAQUI <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger ❑ Cable Tool 0 Push Point 0 Other N ENV/R ON N NOUN <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom D Gravel Pack/Gravel ARrUp,_—ZIF diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth it <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched 0 Steel 0 Plastic ❑ Stainless Steel 0 Other <br /> Grout Seal Depth ft 0 Neat Cement(94 Ib bag/5-10 gal water) 0 Sand Cement <br /> sack mixl7 gal water <br /> Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller �-OPump Contractor 0 Other <br /> C Concrete Pedestal Dims:Width ft Length ft Thick in 0 Christy Box ❑ Stove Pipe <br /> PUMP 0 Submerrsiblec2laTprbine ❑ Other HP Pump Set 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 /> MINIMU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED TITLE CEO <br /> DATE 51141201 R <br /> PUMP/WELL Is located approx.0.42 miles y�� _. �l , <br /> from Guthmiller Rd.at the end of the dirtA <br /> N <br /> tract. <br /> 4NOCETI FIRMS <br /> c . <br /> DE I A R T M E N T U E rNIIY <br /> Application Accepted By Date Zt <br /> AreaEmployee ID#� <br /> Grout Inspection By Date <br /> SPECIAL Well Permit <br /> Pump Inspection By Date <br /> WAIVER Received <br /> Soil Boring Inspection By Date <br /> COMMENTS /i - f �� -r `, ,127 Constructed Well Depth ft <br /> PE Sc Received Che Amount <br /> Codes Info By Date Permit! <br /> as Remitted Service Request# Invoice# Well ID# <br /> 3a9/ .�9� � �1 Lj Po6 3* � l <br /> EHD 4306 <br /> 8/04108 <br /> WELL/PUMP PERMIT <br />