SU0013197 - Laserfiche WebLink

Home Browse Search

#3586 WELL/PUMP PERMIT SAN JOAQUIN COUNTY E\VIRONxtENTAL HEALTH DEPARTMENT 304 E WEBER AVE 3"'FL-S OCK I n CA 95202 -(209)469-3420NON-REFUNDABLE PERMIT (_-ALL(209)953-7697 FOR INSPECTIONS EXPIRES YEAR FROM DATE ISSUED N JneADDRESS 4946 E. Eight Mile Road CITY/Zip Stockton 95212 - a CROSS STREET APN 086-070-09 PARCEL SIZE 734 ro OWNER NAME Fay Lan Gong PRonE 475-0312 ONVNERADURESS same CITY/STATE/ZIP CONTRACTOR Delta Stockton Pump PRONE 466-9625 411 CONTRACTOR ADDRESS 646 S. California Street CITY/STATEIZIP Stockton, CA 95=03 SUBCONTRACTOR_ PIIONI: SUBCONTRACTOR ADDRESS CITY/STATE/ZIP t`i LR_ENSE 0C-57 V(C.61 OD-09 ❑Other 724778 NUMBLR ExrIRATION DArE (�'I GEOGRAPHICAL INFORMATION: Coordinates X !' 'township Range Sectbs V� INS ENDED USL DOMCNI(IPRVate l7 Irrigation(Agricultural ❑Indusuial O Water Quality Monitoring ❑Soil Sampling/Characterization ❑Public Watcr Svstem } If dirfercm fmm Lwiirr .aery.mm:a:rrr Con�o .n ,r TYPE OF WORK O New Weil ❑Replaccmenc Well ❑Well AlterationiModifcauco O Test dole ❑Other ❑Monitoring Wcll(s)_ nm bcr vl-N O Soil Boring(s) n ,bcr orb-mg' ❑Geotechnical - O1"'11Cf Or Mnny ,` O Well Destruction ❑Out-Of-Service Well OOut-Of-Service Well Renewul 1H1t1 ❑New Pum 3(7 Plump Replacement ❑Pump Repair O Cruss-Conncnion Repair WELL CONSTRUCTION Drilling Method ❑Mud Rotary ❑Air Rotsry O Auger O Cable Tool ❑Push PDin: ❑Other Proposed Wdl Depth It Excalation in diameter ❑Open Bottom ❑Gravel Pack/Gravel Sin —in diameter ❑Conductor Casing in diameter / Conductor Casing Depth It Well Casing Diameter in ThicknesslGaugrJASTM Schell ❑Steel ❑PIP-mic ❑Stainless Steel ❑Other Grout Seal Depth it O Neat Cement(94 1h hug/5-10gu1 wafer) O Sand Cement_ .- .cock ind/7 gal water ❑Bentonite(20%solids) ❑Manufac[urerSpec%solids % Name_ ❑SpecsonFile OSpecsSubmitted Grout Placement Method ❑Pumped ❑Free Fall ❑Oti•cr ❑Ret::rdanl/Accelerator(name) PEDESTAL Iasta� ODriIler ❑Plump Contractor 0Other-_-_ O Coacrrte Pedestal Dimensions: Width__ R Length—P Thick in ❑Christy Boz ❑Stove Pipe PUMP yl Submeniblc ❑Turbine El Other .ei Pump Set 147 It Standing Water Level ]5 fl. WELL DESTRu nON ❑Open Bottom ❑Gravel Pack O Uncased ❑Other Wcll Diameter in Total Depth__ rt [,`cpth to Watrr It Cl Casing to be Pertoratcd from ft to R Sealing Material O Neat Cement(94 lb hug/5-10gu1 wutrr) O Sand Cement auck—/7 gal water ❑Bcutonilc Pellets ❑Bentonite(20%solids) ❑Manufacturer Spec%solids_—% Name ❑Specs on File ❑Specs Submitted Pbtcemeot Method ❑Pumped ❑Free Fall ❑Other ❑Complete with Mushroom Cap__ R 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 COMPENSATION LAWS, NIINIMUNI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPF.C'1'1O^S SICKED TITLE CEO DATE 09/30/03 KI IV -+F1 11JAi S ,A S CR tEN L CAL I DEPART-E-USE ONLY Application Accepted By _ L?ale /C-; - - '-' Arca. I I Emoloyee ID# Grout Inspection By _ _ Date ❑ SPECIAL Well Permit %q Pump Inspection Dale /-/S'�?�G_ ❑ WAIVER Received Destruction Inspeation By Date Constructed Well Depth It COMMENTS_ PE SC Amount eck#/ Received P Codes lora Remittedas By Date frier Request# [.voice# Well 114 EHD 49-02-006 MASTER WATER WELL PERMIT 5/712002