HomeMy WebLinkAbout006-270-002 EH-WP-26-0071 APPLICATION NEW SMALL WELL (1)WATER WELL
CONSTRUCTION PERMIT
Small Diameter Domestic Well (casing 8 inch diameter or less)Large Diameter Well (> 8 inch diameter)
Public Water System Well Repair/Deepening (same pump capacity)Destruction Fire Suppression
Replacement, Same Pump Capacity, 100 ft of destroyed well Frost Protection
Update: May, 2022
Date paid: ______ $_______________
Receipt No. _________
APPLICATION
APN #: ______________________________ TRAKiT #: ______________________________
Applicant Name (Please print) Property Owner Name
Applicant Mailing Address Construction Site Address
City State Zip City State Zip
Applicant Phone Number Property Owner Phone Number
Drought related (dry well, subsidence)? Yes No
Subbasin: Wyandotte Butte Vina Outside of Subbsasin C-57 Well Driller Name
GSA: Proposed Depth: Casing Diameter:
The Important Information for Applicant/Property Owner (located on the back of this page) has been reviewed by applicant or, if the applicant
is not the property owner, the information has been shared with the property owner. Yes No
Additional Information for Large Diameter Wells Only
Within Water District? Yes No Engineered Pump Capacity: GPM
Name of Water District: Acreage of Parcel(s) to be Served:
If other wells also serve the above referenced parcel(s), provide an attachment that specifies for each well: (1) APN, (2) Pump
Horse Power, and (3) Pump Capacity in Gallons per Minute (GPM). Note: Maximum pump capacity is 50 GPM/acre served.
Applicant Acknowledgement
As the applicant, I am: the property owner, the C-57 licensed well driller, the property owner’s authorized representative.
I certify that the information in this application is correct to the best of my knowledge.
Applicant Signature Date of Application
PERMIT
CONSTRUCTION APPROVAL
This permit is issued based on review of the attached design and it has been determined that it meets the requirements of Butte County Code
Chapter 23B, Water Wells. In coordination with Butte County Department of Water and Resource Conservation and local Groundwater Sustainability
Agencies, the County determines that it is not likely that the proposed well will interfere with the production and functioning of existing nearby wells,
and further, that the proposed well is not likely to cause subsidence that would adversely impact or damage nearby infrastructure.
Environmental Health Specialist Date of Issuance
Comments/Conditions:
FINAL APPROVAL AND CERTIFICATE OF COMPLETION
Well Construction/Destruction Approval Well Final Approval/Certification of Completion
Environmental Health Specialist Date Environmental Health Specialist Date
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Applicant: See important information on reverse side of application.
006-270-002
John J. Valine, Nicole M. ValineJohn Valine
3332 Eaton Village Dr.
Chico CA 95973
3034 Camelot Ct.
Chico CA 95973
(530) 828-0771
Shane Besser
(530) 828-0771
x
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250'5.00"
x
11/05/2026
x
Vina Subbasin