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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)4683420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ohd EXPIRES 1 YEAR FROM DATE ISSUED <br /> rn <br /> Joe ADDRESS 123 Van Dervin Parkway CITY/ZIP Stockton, CA <br /> D <br /> CROSS STREET Frank W Cir APN 193-370-02 PARCEL SIZE 38 ac LAND USE APPLICATION# a <br /> to <br /> OWNER NAME Scott Paris PHONE w <br /> OWNER ADDRESS 3416 Newton Road CITY/STATEILP Stockton, CA, 95205 <br /> CONTRACTOR West Coast Exploration PHONE 209-985-7541 <br /> CONTRACTOR ADDRESS PO Box 133 CITY/STATEZP Escalon, CA 95320 <br /> SUBCONTRACTOR/CONSULTANT ENGEO Incorporated PHONE 209-684-7604 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 17278 Golden Valley Parkway CITY/STATE/LP Lathrop, CA, 95330 <br /> LICENSE Z C-57 C-61 -D-09 Other NUMBER 870761 EXPIRATION DATE 1-31-20 <br /> BILLING PARTY: -OWNER -1 CONTRACTOR $ SUBCONTRACTOR/CONSULTANT <br /> DONI WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)--Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring x Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification -Other <br /> Monitoring Well(s) #of wells x Soil Boring(s) 1 #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> - New Pum Pump Replacement I Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method -Mud Rotary j Air Rotary x Auger I�Cable Tool Push Point i Other <br /> Proposed Well Depth 30 ft Excavation 4 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched - Steel -Plastic - Stainless Steel Other <br /> Grout Seal Depth 30 ft Neat Cement(941b bagl5-10 gal water) Sand Cement sack mixR gal water <br /> x Bentonite(20%solids) Other <br /> Grout Placement Metho umped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller [ Pump Contractor - Other <br /> Concrete Pedestal _,Dimensions:Width ft Length ft Thick in C Christy Box --Stove Pipe <br /> PUMP Submersible-Turbine .-Other HP Pump Set ft Standing Water Level It <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 I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED a...n- .-� TITLE Staff Engineer DATE 08-26-19 <br /> .y <br /> iR p vZ,�, ®�,�, <br /> y��N yF�Cp�4 <br /> �RT�F ry <br /> NT <br /> At MNT UjS E OJA LY <br /> Application Accepted By ate '� Area-� Employee ID#)�k;*- 7 <br /> Grout Inspection By Date J7 tVIij SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS 41kbVA <br /> PE SC Received Check#/ Amount Permit/ <br /> des Info ash emitted Date Service a uest# Invoice# WeIIID# <br /> Q� <br /> EH0 43-06 8/11/2019 WELL/PUMP PERMIT <br /> �x� 9s�7el3�� <br />