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817 <br /> WELLIPUMP 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 /> JOB ADDRESS 24226 E Hwy 4 CITY/ZIP- Farmington 95230 m <br /> CROSS STREET Stanley APN 187-11-025 PARCEL SIZE 55.59 LAND USE APPLICATION M <br /> m <br /> OWNER NAME Erick Sorenson PHONE 209-244-6030 <br /> OWNER ADDRESS 24460 E. Hwy 4 CITY/STATE/ZIP Farmington, CA 95230 <br /> CONTRACTOR Delta P l7 rn p I n C PHONE ( 2o9 )466—c)625 <br /> CONTRACTOR ADDRESS 646 S. California St CITY/STATE/ZIPStockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE C-57 EXC-61 ❑ D-09 ❑ Other NUMBER 1055434 EXPIRATION DATE 8/16/2 0 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE XDomestic/Private a Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring ❑ Soil Sampling/Characterization <br /> El Public Water System <br /> If difforenl from Owner. Water System Name ContaCt Name or Phone Number <br /> TYPE OF WORK ❑ New Well 2, Replacement Well ❑ Well Alteration/Modification a Other <br /> Monitoring Well(s) #of wells C Soil Boring(s) of borings ir^ <br /> ❑ Geotechnical ' � ,�� <br /> Out-Of-Service Well C Out-Of-Service Well Renewal ❑ Cross-Connection Repair D <br /> 7 New Pump ❑ Pump Replacement X Pump Repair 7 Raise Well Casing <br /> WELL CONSTRUCTION 14 <br /> sq N X20 <br /> Drilling Method :iMud Rotary Air Rotary Auger [iCable Tool ❑ Push Point Li Other �Oq <br /> Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Grave§4�TN r°NM jp 041vr <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft ARTMENT <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel C Other <br /> Grout Seal Depth ft ❑ Neat Cement(94 lb ba9/5-10 gal water) ❑ Sand Cement sack mix17 gal water <br /> 17 Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped ❑ Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br /> PUMP X Submersible? Turbine C Other HP 1.5 Pump Set 147 ft Standing Water Level 135 ft <br /> 1 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 COMBENSAZION LAWS. <br /> / i NIM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED !+ OwdTITLE CEO DATE 7/9/2020 <br /> Pump is located inside the garage <br /> r <br /> k• <br /> DEPARTMENT USE ONLY nn <br /> Application Accepted By Date a?Jd O Area Employee I Dlr�K <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By '/VCS jj.Q l9 't « r�� .L Date q(t OIx07a WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received hock# Amount Permit/ <br /> Info B Date as Remitted Service Request# Invoice# Well ID# <br /> Ll 3&? os o l O $77 $'12 1AP1� y og(� <br /> EHD 43.06 WELL/PUMP PERMIT <br /> 8!04108 <br />