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' r• + WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232-(209)468-34 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> y <br /> JOB ADDRESS 12000 Moncure Rd CITY/LP Ripon.95366 <br /> D <br /> CROSS STREET Sof Mohler Rd APN 257-290-12 PARCEL SIZE <br /> 17'LAND USE APPLICATION# <br /> OWNER NAME Elinor Aufdermaur PHONE 209-599-6606 �^ <br /> OWNERADDRESS 12000 Moncure Rd CITY/STATE/ZIP Ripon,CA 95366 <br /> CONTRACTOR Hennings Bros.Drilling Co. Inc. PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd CITY/STATE/ZIP Modesto,CA 95356 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE x C-57 C-61 D-09 Other NUMBER 290813 ExPIRATIONDATE 05-31-2018 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section_ <br /> INTENDED USE x Domestic/Private i Irrigation/Agricultural Industrial _;Water Quality Monitoring _!Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Nam contaCt Name,or Phone NUmber <br /> TYPE OF WORK x New Well )t Replacement Well i" Well Alteration/Modification -1 Other <br /> Monitoring Well(s) #of wells I r Soil Boring(s) #of borings - Geotechnical #of bodngs <br /> Out-Of-Service Well L Out-Of-Service Well Renewal c Cross-Connection Repair <br /> New Pump Pump Replacement n Pump Repair C Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method x Mud Rotary Air Rotary i Auger ,j Cable Tool 0 Push Point , Other <br /> Proposed Well Depth 250 it Excavation 14 in diameter C;Open Bottom :x Gravel Pack/Gravel Size No.6 in diameter ti Z 2 <br /> Conductor Casing in diameter / Conductor Casing Depth ft Sand pack W <br /> Well Casing Diameter 8 n Thickness/Gauge/ASTM Schad SDR26 Steel tic Plastic ❑Stainless Steel ❑Other — 0 P P <br /> Grout Seal Depth-MV /� ft Neat Cement(94 Ib bag/5-10 gal water) r i Sand Cement Sack mAg.lr N UZ~ <br /> W <br /> x Bentonite(20%solids) Other CV Z 2 0. <br /> Grout Placement Method x Pumped Free Fall a Other Retardant/Accelerator(name) 2tp Z 0 <br /> PEDESTAL Installed By U Driller Ix Pump Contractor ❑ Other m 0 <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in O Christy Box F1 Stove Pipe W 0 <br /> PUMP I Submersibles;Turbine ,'Other HP Pump Set It U— W Standing Water Level 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 CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE ICE REQUIRED FOR INSPECTIONS •� <br /> SIGNED 11.4111111111 TITLE • '�• DATE ;L <br /> o.I Al VI FFF_ <br /> z� <br /> ee <br /> �P RTMENT SE 'ONLY <br /> Application AccepteABy Date 2 Area G Employee I D0 C Grout InspectioDate SP CIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> / C M TS <%it I U— <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Re uest# <br /> 74 Z 7 �12007�07 30 <br /> Z "11-220 <br /> EHD 43-08 WELL/PUMP PERMIT <br /> 8/04/08 <br />