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3 <br /> 20184 WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOBAooREss 4946 E. 8 MILE RD. ciry/LPSTOCKTON CA 95212 D <br /> y / G �UU°I <br /> �Cross$TREE? 99 E. FRONTACF. R$Pf! D U 1P PARCEL sRE 7_ 3 4 LAND USE <br /> 4APPLICATION#1y7 p <br /> OWNER NAME EA-}` �;A-Pl- I `U � J4n F LJ- �r• yPHONE 483E Tb <br /> OWNER ADDRESS SAPSIF 2-y VA G n9ruYe tor— CITY/STATEMP L/Li <br /> CONTRACTOR Delta g,� <br /> FLp– ot <br /> CTnrXT0N ARMATURE E MOTOR nntet; _ 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATPJZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE D C-57 9 C-61 0 D-09 D Other NUMBER 724778 ExPIRATIONDATE 08/j% <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE OXNmestictPrivale C Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> C Public Water System <br /> If different from Owner Wet8f Yom amo Gonlad Narria or one N.M081 <br /> TYPE OF WORK C New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br /> O MonitoringWell(s) #orwetls L;SOrlsorin s aofD0nwKdoww,ys <br /> 9(1 ., 0 Geotechnical <br /> -Out-Of-Service Well C Out-01-Service Well Renewal 0 Cross-Connection Repair <br /> New Pump 0 Pump Replacement Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth h <br /> Well Casing Diameter_in ThicknesWGauge/ASTM Schad D Steel 0 Plastic 0 Stainless Steel 0 Other <br /> Grout Seat Depth ft C Neat Cement(94 ib bag/5-10 gal water) ;;Sand Cement sock m/x/7 gal water <br /> 7 Bentonite(20%solids) 0 Other <br /> Grout Placement Method 0 Pumped 0 Free Fall C Other D Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> Concrete Pedestal Dimensions:Width It Length It Thick in 0 Christy Box 0 Stove Pipe <br /> PUMP O')NbmersibleO Turbine 0 Other HP S Pump Set tt Standing Water Level N <br /> I 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 /> 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED = TmE CEO <br /> DATE3/20/2018 <br /> ;,-S 1 <br /> 4 <br /> HOUSE PUMPWELL Is approx.64.44 <br /> ' ft.from the back of the house <br /> and approx.20 ft.from the <br /> ie unused packing shed <br /> 1 Unused packing <br /> F shed <br /> C <br /> RdN N"( <br /> M � EPARTMENT USE ONLY <br /> A 4, .1 I <br /> Application Accepted By Date 3-.2 6-!y Aroa y C/G, Employee IDN W fir_`y <br /> Grout Inspection By Date SPECIAL Well Permit —� <br /> Pump Inspection By Date WAVER Received <br /> Soil Boring Insp tion By Data Co� Well Depth litCOMMENTS n ) I( ry1�1( eel,, ue.ve <br /> 4-2" <br /> PE Be Racdved ac Amount Permlt/ <br /> Codes info B Remitted Date SeMWRe uestIII Invoice# Well ID# <br /> 43r OS'u 3675 -7 l{l1%Iy �UP003�IZ 1 <br /> EID 49-06 <br /> 6xm= WELL/PUMP PERMIT <br />