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21 066 <br /> 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 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2900 Loomis Rd CITY/ZIP Stockton 95206 m <br /> 99 Frontage Rd D <br /> CROSS STREET g APNI�q/�00 0 . 9 7 0 <br /> PARCEL SIZE LAND USE APPLICATION# V <br /> Bob s Towing '— m <br /> OWNER NAME n� � <br /> PHONE 209-986-3697 N <br /> OWNER ADDRESS SAME CITY/STATFJZIP- <br /> CONTRACTOR Delta--PUMP 4'TOCKTON ARMATURE u MOTQR WORKS 11" 16h. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYIS7ATE)ZIP <br /> LICENSE . C C-57 N C-61 ❑ D-09 ❑ Other NUMBER 724778 EXPIRATIONDATE 08/1� <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE t Domestic/Private 0 Irrigation/Agricultural 0 Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> ❑ Public Water System <br /> If different from Owner: Water ystern Name Contaci Name or Frione Number <br /> TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br /> Q Monitoring Well(s) #of wells ❑ Soil Borin s #ofbonngs of borings <br /> 9O ❑ Geotechnical <br /> 0 Out-Of-Service Well ❑ Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> ❑ New Pump ump Replacement _XPump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool ❑ Push Point ❑ Other Y <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom ❑ Gravel Pack/Gravel Size ' ~• in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter i in Thickness/Gauge/ASTM Schad ❑ Steel 0 Plastic ❑ Stainless Steel ❑ Other <br /> y Grout Seal Depth ft C Neat Cement(94 Ib bag/5-10 gal water) ❑ Sand Cement sack mix/7 gat water <br /> Bentonite(20%solids) 0 Other <br /> Grout Placement Method ❑ Pumped 0 Free Fall C Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor C Other <br /> El Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP Submersible0 Turbine ❑ Other 1 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 /> M(_N111/1U�,.24.HOUAADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED = i, z...... . <br /> TITLE CEO DATE <br /> Aproximately 475 <br /> -� a•* ft from Loomis Rd <br /> 19 <br /> • <br /> J q U T NTS. <br /> • L <br /> NT <br /> EP RTMENT U S E O N L Y <br /> Application Accepted By � Date AIL4e, Area Employee ID#� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By y � Li\O \Qti� Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> PE SC Received C Amount Permit/ <br /> Codes Info B Remitted I Date Service Re uest# Invoice# Well ID# <br /> .3 iq hr ,3 (� <br /> _ I <br /> EHD 43-06 <br /> 8!04/08 WELL/PUMP PERMIT <br />