SR0078972 SSNL - Laserfiche WebLink

Home Browse Search

WELL/PUMP PERMIT SANJOAQUIN Cou,,,,ENvIRONMENTwL HEALTH DEPARTMENT 304E WEBER AVE 3"FL-STOC6TON CA 95202 -(209)46&3420 NON-REFUNDARLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED as 200 Best Rd. crrr/Elr Stockton, CA 95215 JOB ADDRESS (� CROSS STREET COppercpolis APN JC2 _ 220— LI PARCEI.S.M ^•— • OWNSR NAME xareri Rose PHOPIE OWNERADORess 200 Best Rd cmmATE21P Stockton Ca 95215 COwaArTOR Purviance Drillers, Inc. PnoNR209-887-3554 GA CITY(SfATV)PgtnrL•4nn Ca 9r216 CONPMCI'OR ABDREEE ^ �r SUBCONTRACTOR n/ate PRONE SusecowRAQOR ADDRESS CITU/STATE21P LICENSE C?C-57 [3 C-61 13D-09 DOther NUAISER 377923 EXPIRATIONDA IE 7/05 �a CEOORwPRICALINPORMATP0N: Coerellmues X Y ToWnship� Itukasa — Secftoa__ INTSNOEOUSE O Domionic/1"woue O lrrigatioNAgriculmnl O Industrial ❑Water Quality Monitoring ❑Soil Sampling/Chancwrintion -'1' ❑Public Water Srarem �, ,,,uw M ", ", I Bniftumrrrom D„ mer yewn .me � �"J �. TrPE OE WORR 13 No-Well ❑Repbemnent Well ❑Well Ntemtiotl/Madificalion ❑Test Holc 13 Other O Monitoring W-11(s), pV1itorofwils O Soil Bwalt(a) °"niearoreminss 0Gtoeohmool °�'marsorbemlp 0 Well Deatnsction 0Om-0f4serviee Well ❑Oul-0f-Soria Well Renewal Ate' ❑New Pump apurepReralacromen, ❑Pump Restair Cl C.-C.,neclion Repair WEIA,GQNBTROLTION Drilling Metbed ❑Mud Rotery 0 Air Rmary ❑Auger ❑Cable Tool 0 Push Poise ❑Outer n Proposed Well Depth H Pzcavation io diamcwr 0 Open Bouom O Gavel Peck 1 Q.,,B Six in diuneta — 13ConductorCasing in diameter / Conductor Casing Depth R Well Cuing Diameter_in ThicknesdOsuplASTM Sched ❑Steel 0 Plastic 0 Stainless Steel ❑Olhnr Grout Seal Depth R 0Neu Cerium(94 lb hog/3-10So/srorerl ❑Sand Cen=t sm*aro,/7 gad weds, O Domasiw(20%Solids) ❑Manufactuar Spm%solids__% Name ❑Speeson File ❑Specs Submitted Grout Pbamevs Method ❑Pumped OFrce Fell ❑Other OReandant/Aceelare.(houO PEOESTAL Installed By ❑Drillor 0 Pump Conmewr ❑Other O Concrete Pedestal Dimensions: Width ft Length P Thick in OChrist,Bos 0ShiiePipe PUMP W Submensiblc O Turbine 0 Other FIP_ A Pump So 1 3 6 R Scalding Water Low)_9 6 ft WELL DPSTRUCTION ❑Open Bdrom ❑Gavel Pack ❑Unwsed ❑Other Well Dumas_in Total Depth ft Depth.to Wattt B 0 Casing to be Penbawd Ram__D to_R • SeaEag Material 0Nen Cement(94/h bug/S-JOgm(,W,rey 13 Send Cement ook on.17 gal were, 0 Benwnite Pelices 0 B000mw(2t W.solids) ❑Manufectuser Spa%solids % Name. ❑Specs an File ❑Specs Submitsad Placemevs Motbod ❑Pumped 0 F.Fall ❑Other O Complete with Mushroom Cap ftbelow grade O Complete to Existing Suds"Pad I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL HE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND RECULdLTIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPEN NLAWS. NIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS St Tln Corporate Secretary DATE 8/22/3 F VL 0 DEPARTMENT USE ONLY ,T 1 l APPlicarion Accepted By �' Date '— �li �rJ 1 Area �+� Employee IDB ll Grout inspection By Dale El SPECIAL Well Permit Pump InspectionI Owes / ��i.'�-� [3WAIVER REceiVed Dalmction Ivspalion By Due Constructed Well Depth n COMMENTS • PE Sc Amount re, Received Data Permit/ Drvoiue0 Wc{{{DO Codes Into Resettled Cash BY Service Re i ca re b'0 5C 5� v o —2b I EHD 43-02-006 MASTER WATER WELL PERMIT 580002