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20506 WELL/PUMP PERMIT <br /> §AN JOAQIIIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue•STOCKTON CA 952054232-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> E. FOPIANNO LN v <br /> JoaADDREss b599 CIrY/ZIP STOCKTON CA 95212 (m <br /> b <br /> cRosasTREe-r SOLARI RANCH RD APN Q86-41-020 PARCELsrzE <br /> __�.�Q_�.AND iJ3E APPLICATION// A <br /> OWNER NAME _ AZTE KAMAL1 ✓ �� � PHONE 456-2003 <br /> ONMER ADDRESS SAMF CITY/STATEMP <br /> (CONTRACTOR _ Del PrrmD CTi1r'KTtIN ARMATi1RF & MOTOR WORKS 1151161&—M-466-9625 <br /> ICoWRACTORADDRE45 646 S. California Street CrrY)STATFJZIP Stockton, CA 95203 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCONTRACTOR ADDREas CRYdSTATEJZIV <br /> LICENSE 0 C-57 X C-61 0 D-09 0 Other <br /> NuK6cR_ 724778 ExPdRAnokDATE <br /> aEoORAPHICAL INFORMATION: Coordinates,X Y <br /> INTownship—Range_ Section_ <br /> TEN0.�n USEjp�bmest1dPrivate 0 Inigalion/AgrWiturai 0 Industrial O Water Quality Monftoring O'Soil Sempling/Characteriza0on <br /> C Public Water System <br /> If dift—t horn os— n oma <br /> a e r <br /> TYPE Or:WORK 0 New Well 0 Replacement Weil 0 Well AfteratbNModirication 0 Other <br /> O MorNtodng WetKs) dorwefts j Sol(Sonng(s) *00orbpa Naaw�.ge <br /> :1 Out-0t-Servks Weil 0 Geotechnical <br /> 0 Out•OtService Well Renewal 0 Cross-Connection Repair Pj� <br /> O New pump m Re acemerll 0 Pum Re b <br /> �-p 0 Rose Weil Casin <br /> WELL CONSTR ION r <br /> Drilling Method 0 Mud Rotary <br /> Proposed Well Depth 0 Air Rotary D Auger O Cable Tool 0 Push Point 0 Other Fp, <br /> ft Excavation <br /> in ctor eterCasing <br /> 0th Bottom D Grave!PackJGravel Sgt T___ tt filer <br /> D Conductor Casing in diameter ! Conductor Casing OepN ft <br /> Well Casing Diameter`in Thicknest/Gauge/ASTM Schell D Steel 0 Plastic 0 Stainless Stool t V/ <br /> Grout Seat ,.p,,, g? <br /> f?OA, /COVry <br /> tt r10 gat wetel� 0 Sand Cement <br /> M <br /> C Bentonite(20%scilds) 0 other rt111QT ver <br /> O Neat Cement!94 Ib ba � <br /> Grout Placement Method 0 Pumped 0 Free Fall 0 Other / <br /> O Retardant lAccelerator(name <br /> 1.PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other ? <br /> C Concrete Pedestal Dimensions:Width It Length ft Thick <br /> in O Cbrtaiy Bo 0 Stove Pipe <br /> LUMP __XY—SubmerslbleO Turbine 0 Other <br /> HP S Pump Set ft Standing Water Level k <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE <br /> JOSAN <br /> AQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS,WORK WILL BE DONE IN ACCORDANCE WITH t 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 COMPEN <br /> �/ MINI M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> 31GNEb_- TITLE CSO <br /> DATE&/271­ <br /> 2018 <br /> --------------------- <br /> Tom---- *--r-� <br /> I I t PUMP/WELL Is located ,'' - � ,.• , <br /> approx.387.72 ft.under ! ` <br /> r the trees frorn the road. <br /> I F r{ <br /> F ...1.. !F 1"may, 4� 4 -i'�' S.t,^- •4 S. <br /> D AR MENT USjj oil Y <br /> ApiAcation Accepted By <br /> Gate Area �":'-L <br /> Employee IDN <br /> Grout Inspection By <br /> Date eII Permit <br /> Pump Inspection By Date�. <br /> Soil Sorin In WAIVER Received <br /> 9 Inspection By <br /> COMMENTS Date WAIVER <br /> Constructed Well Depth�_ft <br /> PE SC Received he _ <br /> Cod" into g Amount Date PenniN <br /> Remitted Service Roast S invoice 9 Weil ON <br /> I <br /> EHD43da - <br /> ND>.be <br /> WELLN-LW PERMIT <br />