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r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE•STOCKTON CA 95205.6232(209)4113.3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7910 Longe Street c,TYZP Stockton,95206 _ T <br /> Stimson Street 17726035 1 <br /> CROSS STREET APN PARCEL SIZE [�.a•LLAND USE APPLICATION t <br /> OWNER NAME Craig Walters PHONE 209-982-5585 <br /> OWNER ADDRESS 7910 Longe Street CITY/STATEZP Stockton,CA 95206 oc <br /> x <br /> CONTRACTOR Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> f <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CiTY/STATE/bp Fresno,California 93722 <br /> SUBCONTRACTOR/CONSULTANT Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> C <br /> SUBCONTRACTORJCONSULTANT ADDRESS 4729 West Jacquelyn Avenue C,TY/STATE2IP Fresno,California 93722 <br /> LICENSE V C-57 C-61 D-09 Other NUMBER 970772 EXPIRATION DATE 3/31/2020 <br /> BILLING PARTY: OWNER CONTRACTOR J SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) v <br /> INTENDED USE Domestic/Private Ihigahon/Agricultural Industrial Water Quality Monitoring ✓Sal Sampling/Charactenzabon <br /> Public Water System o <br /> It htler,nt from Owns VIM.,SO]—Name Contact Nem,or Ph—Number <br /> TYPE OF WORN New Well Replacement Well Well AlterahonfModificabon Other r% <br /> F <br /> Monitoring Wells) t of wells Sod Bonng(s) 00t,111,11 ✓Geotectlnical TWO a°t Wni,g. <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing w. <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary V Auger Cable Tool 7 Push Point Other <br /> Proposed Well Depth n/a ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 20 to 25 it J Neat Cement(94/b bag/5-10 ga:water) Sand Cement sack mu/7 gal water <br /> Bentonne(20%solids) Other _ <br /> Grout Placement Method Pumped V Free Fall ✓Other Tremmie Retardant I Accelerator(name) <br /> sTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions W di;h it Lengtn ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Sel ft Standing Water Level —R 1 <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 /> MINIMUM`48�HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �Gt� cu.t TITLE Geotechnical Staff Engineer DATE 5/19/2020 <br /> I <br /> _le VNT <br /> FD <br /> -2 2020 <br /> RIME- <br /> _ NT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By L L� Date S z'- Lc'z`i Area f ' EmployeelDS <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date ^ WAIVER Received <br /> Soil Boring I cUon By Date (i 0 Constructed Well Depth ft <br /> COMMENTS `^ t Unk!C V ll r C YkOt'!a 2 15 <br /> PE SC Received Amount Date PermilJ Invoice t Well IDM <br /> Codes Into B Cash Remitted Service Requag t, <br /> L E 7,J /s-,D Z77L- S 4- <br /> EHD43-ee 0111 rYJ 19 WELL RUM''PERMIT <br />