My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
WP0040219
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
F
>
FYFFE
>
0
>
4200/4300 - Liquid Waste/Water Well Permits
>
WP0040219
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/1/2021 4:55:54 PM
Creation date
11/1/2021 4:54:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040219
PE
4372
STREET_NUMBER
0
STREET_NAME
FYFFE
STREET_TYPE
RD
City
STOCKTON
Zip
95203-
APN
16203007
ENTERED_DATE
10/25/2019 12:00:00 AM
SITE_LOCATION
0 FYFFE RD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
9
PDF
View images
View plain text
WELLIPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />/ehd <br />1 YEARR FROM DATE ISSUED <br />nn <br />JOB ADDRESS F/�jf- I` d A f2 <br />g nwww.sjggv.Or <br />(2 V !'// v 1. <br />fit -EXPIRES <br />CITY/ZIP J/ 0 G k 7,07) 17 sZ 6 <br />CROSS STREET MpG G Gay Al/ E <br />_ APN 1G 0 0 _PARCEL <br />SIZE'??Z LAND USE APPLICATION #�� <br />OWNER NAME I O n -I 0 r 5-rO? %LTO I/ <br />PHONE Z 0 , 9y4. a zy� <br />OWNER ADDRESS _ Z Z O 4 / W. <br />W I1 r, f -rA47-d g/ S -r • <br />CITY/STATEIZIP `��• rot/,r0 4 %S 2 �3 <br />CONTRACTOR mroQg,:- 4-4,4 4,1- jq <br />G Ey 1GSrZidL <br />yV, 'e <br />" Z <br />PHONE 7�7 - 633 - 3oS <br />c <br />CONTRACTOR ADDRESS T-'/ IV' Lz A411A Sl <br />CITYISTATEIZIP D 1V4Vi E 4A V Z Oe ,z - <br />SUBCONTRACTOR/CONSULTANT Tcw r,-rmG y/`' �. <br />/ <br />PHONE /1G 407 Z Jr' I/ l <br />SUBCONTRACTORICONSULTANT ADDRESS �7 <br />7 Z S,4 �rA AP4 AvF <br />CCIITY//STAATEIIZIP <Jtry" M j�! /G.4/ fr,9j f <br />LICENSE XC -57 D C-61 r] D-09 <br />D Other NUMBER <br />8/ / 415-1 <br />1 EXPIRATION DATE <br />BILLING PARTY: . ' OWNER <br />t CONTRACTOR 13CONTRACTORICONSULTANT <br />DOMESTIC WELL SAMPLING: I General Mineral/Coliform Bacteria (4391) , Dibromochloropropane (4392) , Arsenic (4393) <br />INTENDED USE D Domestic/Private D IrrigationlAgricultural 0 Industrial 1.1 Water Quality Monitoring OLSoll Sampling/Characterization <br />LI Public Water System <br />If different from Owner. Water System Name Confect Name or Phone Number <br />TYPE OF WORK D New Well G Replacement Well rl Well Alteration/Modification dt Other CP T <br />❑ Monitoring Well(s) # of wells 0 Soil Boring(s) # of borinye OLGeolechnical # of ho"mle <br />0 Out -Of -Service Well U Out -Of -Service Well Renewal CI Cross -Connection Repair _ <br />Drilling Method 0 Mud Rotary n Air Rotary D Auger ❑ Cable Tool Push Point n Other ~CIV <br />Proposed Well Depth 0 -/ZO I it Excavallon in diameter 11 Open Bottom ❑ Gravel Pack/Gravel Size ' t t meter <br />❑ Conductor Casing in diameter / Conductor Casing Depth fl 4C2O <br />Well Casing Diameter Z„ in Thickness/Gauge/ASTM Schad n Steel LI Plastic ❑ Stainless Steel n Oth U-_'Dq_jQj g1m,� <br />Grout Seal Depth fl a+1 -Neat Cement (94 Ib bagl5-10 gal water) D Sand Cement F/ <br />D Bentonite (20% solids) ❑ Other 0@P A( <br />Grout Placement Method U Pumped ❑ Free Fall 01LOlher _ H?F U Retardant / Accelerator (name) <br />PEDESTAL Installed By D Driller ❑ Pump Contractor ❑ Other <br />❑ Concrete Pedestal DDtmenslons: Width it Length ft Thick In ❑ Christy Box U Stove Pipe <br />f PUMP n Submersible❑ Turbine D Other HP Pump Set it Standing Water Level it <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAI' 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 />MINIM/UJjN 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7c6-97 <br />SIGNED .7 ,/( TITLE 95'✓rd R---VIA0'`1I DATE /4' -'ZS -/y <br />D ARTMENT USE ONLY <br />Application Accepted By Dale AreaS 1 t `- �gmployee ID# S �- <br />Grout Inspection By Date PECIAL Well Permit <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />Dale <br />Dale <br />WAIVER Received <br />Constructed Well Depth _ <br />PE SC Received Check#/ Amount <br />Codes Info B Cash Remitted <br />D to Permit/ Invoice # Well ID# <br />Service Request # <br />-1 I <br />EHD 4,100 611112019 WELL (PUMP PERMIT <br />-77`73 (,-cq2-- <br />2 a �►, �G B, 3 ea o <br />�s3 <br />y <br />7�1- <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).