SU0005955 - Laserfiche WebLink

Home Browse Search

WELL /PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEMENT 304 E WEBER,&. FL-STOCKTON CA35201_'(209)468-3420 NOS'- EFUNDABLE PERMIT CALL CALL 209 953-7697 FOR INSPECTIONS ExPIRES ] YEAR FROM DATE IS ED JOB ADDRESS (/ iCITY/ZIP !z� tan _ � J y CROSS STREETts RdAPN - 0 6 5—1 8 0—0 3 PARCEL SIZE / r OWNER NAME Lewa l l en Land}! and Cattle PHONE OWNERADDRESS P. O• BOX 5851 CITWSTATE/ZIP Linden, Ca . 95236 r i CONTRACTOR Purviance Drillers Inc PHONE 209-887-3554 CONTRACTOR ADDRESS P OBOX 64 , CITY/STATE/ZIP Linden, Ca 95236 SUBCONTRACTOR n a PIIONE {" SUBCONTRACTOR ADDRESS !1 CITYISTATEIZIP E LICENSE E C-57 ❑C-61 ❑D-09 1 ❑Other NUMBER EXPIRATION DATE i GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section INTENDED USE R Domestic/Private ❑Irrigation/Agricultural ❑Industrial ❑Water Quality Monitoring D Soil Sampling/Characterization ❑Public Water System I ]rdifferent from Owner: Water System Name fContact Name or PhDno um 'r — TYPE OF WORK X New Well ❑Replacement Well ❑Well Alteration/Modification ❑Test Hole ❑Other ❑Monitoring Wells number or wetis number of borings number oorn 11 Soil Boring(s) ❑Geotechnical bf borings ❑Well Destruction ❑Out-Of-Service Well ❑Out-Of-Service Well Renewal N New Pum - ❑Pump Replacement ❑Pump Repair ❑Cross-Connection Repair WELL CONSTRUCTION Drilling Method R Mud Rotary [3 Air Rotary ❑Auger ❑Cable Tool ❑Push Point ❑Other Depth Well Proposed t p p 3 2 a ft Excavation 12 in diameter N Open Bottom IJ Gravel Pack/Gravel Size in diameter ❑Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter 6 in Thickness/Gauge/ASTM Sched . 13 4 dal Steel ❑Plastic ❑Stainless Steel ❑Other Grout Seal Depth 2 6 0 ft ❑Neat Cement(94 lb dub l5-l0 gal water) ]0 Sand Cement I sack rnix 17 gal water ❑Bentonite(20%solids) 0Manutacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted Grout Placement Method 0 Pumped ❑FreeFall ❑Other 13 Retardant/Accelerator(name) PEDESTAL Installed By ❑Driller ❑Pump Contractor ❑Other r ❑Concrete Pedestal Dimensions: Width ft Length ft Thick in ❑Christy Box ❑Stove Pipe PUMP R Submersible ❑Turbine ❑Other HP__a_ Pump Set_ 2 31 tt Standing Water Level ft WELL DESTRUCTION 13 Open Bottom 1 ❑Gravel Pack ❑Uncased ❑Other Well Diameter in Total!Depth ft Depth to Water R ❑Casing to be Perforated from tt to ft Sealing Material ❑Neat Cement(94 lb h(rglS-l0 gal wafer) ❑Sand Cement sack rnix/7 gal water ❑Bentonite Pellets ❑Bentonite(20%solids) ff Manufacturer Spec%solids % Name ❑Specs on File ❑Specs Submitted Placement Method ❑Pumped ❑Tree Fall ❑Other ❑Complete with Mushroom Cap ft below grade ❑Complete to Existing Surface Pad I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL- WORKERS COMPEN N LAWS. NIMUM-24IHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS SIGN i TITLE Corporate ,Secretary DATE /30/03 t t i 1 I 1 { C U At Z I c fN EPARTMENT US ONL Application Accepted By Date �F - Area ( / Y 1 Employee ID# Grout Inspection Date /b� ❑�SPECIAL—Well Permit '7 Pump Inspection By Date ❑ WAIVER Received Destruction Inspection By Date /G. Constructed Well Depth COMMENTS ft PE S6. Amount IChetj#V Received Dat .Permit! Codes Info Remitted ash By e Service Request# Invoice# Wel!ID# 1367� 131) Z Zoe, t D3 032621 '2d 3 2- 1 EHD 43-02-006 MASTER WATER WELL,PERMIT 5/7422002 .