Laserfiche WebLink
WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP Stockton 95206 <br /> CROSS STREET near 3535 Perlman Dr. APN ' PARCEL SIZE .a{BLAND USE APPLICATION# o <br /> 7�� z <br /> OWNER NAME City of Stockton Municipal Utility Dept. Job#M16010 PHONE 209-937-8700 w <br /> OWNER ADDRESS 2500 Navy Drive CITY/STATE/ZJP Stockton CA 95206 <br /> CONTRACTOR Farwest Corrosion Control PHONE 510-952-6256 <br /> CONTRACTOR ADDRESS 2223 Commerce Place CITY/STATE/ZIP Hayward CA 94545 <br /> SUBCONTRACTOR n/a PHONE We <br /> SUBCONTRACTOR ADDRESS n/a CITYISTATE/ZJP n/a <br /> LICENSE ZC-57 DC-61 ❑D-09 DOther NUMBER 248232 EXPIRATION DATE 12-31-2019 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private llI�ttigatien/Agricultural Ljndustrial "Water Quality Monitoring _Soil Sampling/Characterization <br /> Public Water System <br /> It different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK ZNew Well -Replacement Well _:Well Alteration/Modification ✓ Other Cathodic Protection <br /> O Monitoring Well(s) #of wells QSOil Borings) #of borings Geotechnical #of borings <br /> Out-Of-Service Well -!Out-Of-Service Well Renewal Cross-Connection Repair <br /> _.New Pum -Pump Replacement - Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ✓Mud Rotary DAir Rotary Auger r Cable Tool -!Push Point ❑ Other <br /> Proposed Well Depth 45 ft Excavation in diameter Open Bottom Javel Pack/Gravel Size in diameter <br /> Conductor Casing n/a in diameter / Conductor Casing De th n/a ft <br /> 1 <br /> Well Casin Diameter t in T i ness/Gauge/ASTM Sched PVC Sch 80 Steel Plastic Stainless Steel 11ther <br /> I rout Seal epth. QNeat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) -jOther <br /> Grout Placement Methods•l-kmped __ Free Fall .Other Tremmie Retardant/Accelerator(name) <br /> PEDESTAL Installed By ODriller [ Pump Contractor Other M--- <br /> Concrete Pedestal nDimensions:Width It Length ft Thick in Christy Box i.1 Stove Pipe <br /> PUMP Submersible Turbine : Other N/A HP N/A Pump Set N/A ft Standing Water Level wA It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY OR423re <br /> ATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVEALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS PENSAT <br /> MI IMUM 4TIC EQUIRED FOR SPECTIQNS PLEASE CA (209) 3-7/6)!97 <br /> SIGNED TL ✓ DAT ✓/` <br /> S E E P L A N S F O R D E T A I L S <br /> LI <br /> PA M E N T U E O LY <br /> r <br /> Application Accepted By Date Area ✓ Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permlt <br /> / Pump Inspection By Date WAIVER ReC2lved t <br /> G,�IS J Soil Boring I <br /> S pection By Date Constructed Well Depth ft <br /> CO ENI <br /> PE SC Received Check#/ Amount Invoice# Well ID# <br /> Permit/ <br /> Codes Ifo B Cash a itted Date Service Re rest# `v <br /> Ste- <br /> EHD 43-06 revised 4/14/18 / �..�L* v( Q r[- I y��7 WELL/PUMP PERMIT <br />