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#8917 WELL/PUMP PERMIT <br /> SAN JOAQM COUNTY ENVIRON1tgNTAL HEALTH IMPARTMENT 600 E.Main Street-STOOK-TON CA 95202- (209) <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FoR INSPECTIONS EXPIRES I YEAR FROM I <br /> vv <br /> JOBADDRESS 12650 Platti Road Cr"1w Tracy 95304 <br /> CB7.5.$STREET Tracy Blvd. APN �12-700-03 PARCEL Sue ' "LAND USE AppLICITION t! <br /> Owrc[ttNA.Nm Louis & Betty Galli PeON'E 836-4046 <br /> OWNER ADDRESS same Crrv1St'ATEPLIP <br /> CONTRACTOR Delta Pump PBoNz 209-466-9625 <br /> CONTRACTORAim;tm 646 S. California Street cnwsTATvjw Stockton. CA 95.203 <br /> i <br /> 1 <br /> SUBCONTRACTOR _ PRONE Ii <br /> SUBCONTRACTOR ADDRESS CMISTATE/ZILP f <br /> LICENSE OC-57 XIC-61 C1D-09 ❑Other NuMSER 724778 EXPIRATION DATE 8/08 <br /> GEOGRAPHICAL IN•FORMATION� Coordinates X Y Townshlp Range Section <br /> I.NTENTIFO USE (i Domestic/Private ❑IrrigatiordAgricultural 0Industri3l O Water Qaality Monitoring 0$oil Sampling/Chumctenzattion <br /> ❑Public WaterSyS[em <br /> 1f diff«vut Som Owoa: a« ynrm a uCi eme« um <br /> T'ZPE OF WORK O New Well O Replacement Well ❑Well AlteratioruModification D Other <br /> C o(haric�gs <br /> O Monitoring Wel](s) o of wells O Sol Boring(s) cO�bOl1°g' ❑Geotechnical ' <br /> ❑OutofScrvicc Welt O Out-Of-Smicc Well Renewal ❑C1vss.Connomon Repair <br /> ❑Neu•Pump Co Pum Re taceatent ❑Pump Repair <br /> Wc.TLCONSrt?CiCTION <br /> Drilling Method D Mud Rota ryO Air Ro <br /> tary ❑Auger ❑Cable Tao! 13 Push Point ❑Other <br /> Proposed Well Depth ft Excavation in diameter ❑Open Bottom O Gravel Pack/Gravel Sue in diameter <br /> O Conductor Casing in diameter / Canducior Casing Depth fl <br /> Well Cuing Diameter_in Thickness/Gau cIASTM Sched O Steel D Plastic D Stainless Steel ❑Other <br /> Grout Seal Deptp ft O Neat Cement(9416,bog/5-l0 gal water) ❑Sand Cement sack mix/7 gal water <br /> ❑Bontonite(20%solids) ❑Manufao mr Spce%solids!% Name•_ ❑Spoes on Pile ❑Specs Submitted C <br /> G rout Placement Method O Pumped ❑Free Pall ❑Other O Retaniant/Accelerator(name) <br /> PP•DESFAL Installed By O Driller ❑Pump Coatraator ❑ Other ' <br /> ❑Concrete Pedestal Dimensions:Widal _ft Length —ftThick in ❑Christy Boz O Stove Pipe f <br /> ger =ubmersible ❑Turbine O Other Pnmp Sct 7 0 2 ft Standing Water Level I 1 ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED TRIS APPLICATION AND TrAAT TIRE 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 /> ��UM4 HOUR ADVANCE NO"!ICF'REQUIRED FOR INSPECTIONS <br /> StcNEO /' Tln.c CED DATE 12/18/07 <br /> U <br /> I <br /> t <br /> P <br /> 0 rJ <br /> ENT <br /> DEPARTMENT USE ONLY S <br /> Application Accepted By_ Dnte % f Area Employee ION0 <br /> Growl Inspection By Dan [2 SpEcLkL WeU Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Constructed Wel wepth <br /> MMBNTs <br /> coG' <br /> PE SC Received Amoaat ermit/ Invoiced WCBID* <br /> Codes Info By Cash Remitted ! Date 9e ce nes <br /> I <br />