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Piw -7-11-1b �7rh <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTALHEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> N <br /> Joe ADDRESS 47999 S MacArthur Rd CITYIZIP Tracy CA 95377 > <br /> W.Lille Rd. 253-150-W 44 0 <br /> CROSS STREET APN Ob PARCEL S¢E�v LAND USE APPLICATION m <br /> OWNER NAME Robert Chartier PHONE 510.396-7579 m <br /> OWNER ADDRESS 32932S MacArthur Rd. CITYISTATEIZIP Tracy,CA 95377 <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATEIZIP <br /> SUBCONTRACTOR Martell Water Systems,Inc. PHONE 925.432-4282 <br /> SUBCONTRACTOR ADDRESS 1818 Loveridge Rd. CITYISTATTUZIP Pittsburg,CA 94565 <br /> LICENSE VC-57 VC 61 D-09 Other D-21 NUMBER510952 EXPIRATION DATE 5131/17 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range_ Section_ <br /> INTENDED USE V Domestic/Private - IrrigalionlAgricultural - Industrial Water Quality Moniloring - Soil SamplinglCharacterization <br /> Public Water System <br /> It dr.,w a hem Owner vi' , nen, amu an an Biro°r ere um i <br /> TwE OF WORN New Well Replacement Well -Well Allerallon/ModiGcation Other <br /> Monitoring Well(s) 0 of wells Sod Bonng(s) °I twurq: Geolerhn-cal of eov,ps <br /> Out-Of-Service Well Out-01-Service Well Renewal Cross Connection Repair <br /> New Pump PUmD Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTON <br /> Drilling Method`/Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 700' 11 Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It 3 H P <br /> Well Casing Diameter 5=in Thickness/Gauge/ASTfd Sched Certa-IOC Steel Plastic - Stainless Steel - Other <br /> Grout Soal Depth 200' It Neat Cement(94 Ib bag/-5-10 gal water) Sand Cement 103 sack at water <br /> VElentomle(20%solids) Other grout seal pending on E-long and lithology finding 680r <br /> Grout Placement Method Pumped Free Fall . Other - Retardant/Accelerator(name) <br /> $TA Installed By -Dnllef�I- Pump ContracloF, V Other <br /> Concroto Pedostal Olm ons ions:Width Il Length fl T in BOX Stove Pipo 278 <br /> PUMP Submersible-Turbine Other HP,�K� Pump Set UKN I Standing Water Level UKN ft <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 CO RACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSA N LAWS. <br /> M711=4OUR AD a NO 1 E REQUI D FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED TIRE COO DATE 612116 <br /> APIJO Alp, <br /> PERM <br /> WItfH1Vt 2 '~j�► too I I , — <br /> My <br /> A /� lr <br /> fi?.rmtt m t insp u � <br /> r, <br /> Irl"03ii,being <br /> by DOW }ra.Jq l.r.•.,,w.. . rw <br /> rkt <br /> 3:Ab'w —� r-u•l�K <br /> 4r ib:f 4.37 fiI <br /> .I <br /> :Z <br /> D A,R M E N T USE LY /��/� �c��jj••tt'r t <br /> Application Acceptedto Area _ r' Employee IDq �//vL/�`� <br /> Grout Inspection By Date I SPECIAL Well POrmlt / <br /> Pump Inspection By Date i WAIVER Reeelved <br /> Soil Boring Inspection By Date Constructed Well Depth It <br /> COMMENTS <br /> PE SC Recolved Check#/ Amount PonniU <br /> Codes Info B ash Remitted Dale, Service, <br /> Req�u7esstt 0 Invoice lJ WoII1Dp <br /> EHD 13-UJ -/( / <br />