Laserfiche WebLink
18700 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 I14SPECTIONS E=XPIRES 1 YEAR FROM DATE ISSUED <br /> iq• e us <br /> JOBADDRIraS 14201 VON SOSTE�1/ CITYIZIP TRACY 95304 <br /> Q <br /> CROSS STREET BYRON RD. APN 209-27-015 PARCEL SIZE 2 4 . 8 VAND USE APPLICATION# � <br /> M <br /> m <br /> OWNERNAME R&T FARMS PHONE408 391/I 8401 y' <br /> OWNERADDRESS 488 PA(,nSA WAY CITYISTATE/ZIP_F EMONT M 4539 <br /> CONTRACTOR Delta Pump-STOCKTON ARMATURE & MQQ'QR WORKS ffa11 h. 209-4669625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITYISTATEIZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE ❑ C-57 X C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATION DATE 08 1 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE X)Pomestic/Private ❑ Irrigation/Agricultural D Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> J different from Owner: Water System Name Contact Name or Phone Numl5er <br /> TYPE OF WORK D New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br /> D Monitoring Well(s) #of wells D Soil Borings) #of borings ❑ Geotechnical #of borings <br /> ❑ Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> DNewPump XXPumpReplacement ❑ Pump Repair ❑ Raise Well Casing PAYii <br /> WELL CONSTRUCTION Rt�-1 , <br /> Drilling Method ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point D Other tj <br /> cr V p <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size�� PO)W Teter <br /> p Conductor Casing in diameter 1 Conductor Casing Depkh tt JOAQU <br /> COU <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched 11 Steel 11 Plastic 11 Stainless Steel L� R� k4 <br /> Grout Seal Depth ft n Neat Cement(94 Ib bag15-10 gal water) ❑ Sand Cement sack mix i j t water <br /> ❑ Bentonite(20%solids) 0 Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall D Other ❑ Retardant I Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br /> 0 Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box D Stove Pipe <br /> PUMP ❑ Submersible❑ Turbine ❑ Other__j_FT P_ MFP_-_J_,__-___. Pump Set 4 0 ft Standing Water Level 9 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.l AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS, <br /> M4 IIVfiU 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNEDSTITLE CEO _ DATE 9[7 2 0 16 <br /> 4 PUMP/WELL is located approx. <br /> 133 ft.from the road. See insert <br /> 11ECEIV <br /> 4 r1 �h <br /> J. } w�,'� E MRONMENTAL Ii EQ <br /> `v <br /> PERMIT/33ERV#C C <br /> P F. <br /> Application AcceptedB,� A TeV�Ll_ Date Area Employee 4D#r��5 <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Chec Amount Date Permit/ Invoice# Well ID# <br /> Codes hifo By h Remitted Service Re uest# <br /> Asa 8 D, g k , -7s-7q,--) <br /> EHD 4306 WELL/PUMP PERMIT <br /> 8104108 <br />