Laserfiche WebLink
WELUPUMP PERMIT <br /> Sm JOAQuN CmENVIRONMEMTAL HEALTI DEPARTMENT 1168EASTHP LTONAVENUE-STOCNTON CA 96205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT h CALL(2091963-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> Jm ADDRESS / 109)4^ CArr e-ra At 4kp errrmP R7P0ArF 'A • gS3G s <br /> CROSS 3IREET/'♦!��LLO`. C/�42kOL'rO e�APN�l�S�I.3O-e�Q POACPL 61iE�•4J jIWDU9E APPlJCATONR <br /> OWNERNAMB a oA,4.Ar 4VEfy 0,3 "gaj09 —)1— Ir p...IZa'Y1o07 —AA9 G <br /> OWNERADDIIESS ,gei-435CJs-.^rDa►'ON Rv pmsTATPRro/C f�OoN <br /> CMIRACTDR CANEPA AND SONS, INC. paOgE (209) 532-1136 <br /> COMTaAcmRADDREea 14384 CUESTA COURT cmSTATEQP SONORA, CA 95370 <br /> SUaccar1RnCTOR PMNE <br /> SUBCONTRACWRAo0RE85 CRY/STATE2P <br /> Lmag.. 13 C57 0 C41 ]D-09 =Other NUMBPR 425749 EWRIAT AIDATF 7/31/16 <br /> GE(KRAPHICALINFORMTION: CoordlnatesX Y Township_ Range_ Section_ <br /> INIENOEDU9E DOmealkJPdvale Irrige9onlAgrcultural Olndusalat JWaterQualty Marta«Ing O Sail Sampling/Chmacterizatbn <br /> -Pubna Wat.1SY91.m <br /> n4newn rwa o..eer er em m wa w <br /> Type OF.Wom Now Well XReplacement Well O WellARere9orVModificatbn 0Other <br /> _Monhodig Well(.) aawells uSoilaarhg(e) snrbmeaa uGeoutchrmcal #.flxa,n <br /> OW-014.rvice Well 0 Ou40f-Service We9 Renewal O CrossConnection Repair <br /> New Pum -Nr,p Ra iscemenl n Pp Repair n Raise We6Cmld <br /> WELLCQ Teucnm <br /> Drilling Method X Mud Rotary -Alr Rotary -Auger n C.hle Tool n Pustl Point F Otho <br /> Proposed Well Depth 3W M1 Excavation-12`in tliMneler ]Open 8oaom X Gravel Pack/GrevN Size 3/Sm in tliamoler <br /> X COMuctor CaMrp lB„ hdlamefer / Conductor Cee6q Depth 9tv R <br /> Well Casing Diamaer-10"m TnitlmessfGaugGASTMSciletl ]steel (NPleslic ❑SI.mlese Steel ❑Ogrer <br /> Grout Seal Deplh 190t ft u Neal Cement(941b Dag310 gal want) $Sand Cement 11.3 sack nex galweter <br /> = Benbnite(2 solids] ❑Other <br /> Grout Placement Method X Pumped! OFree Fall 009wr ]Ralardanl/Accelerelor(nane) <br /> pEpSjIBLInaMllatl BY L Ddller .g Pump Contractor Other <br /> -ConereN Pstlestal-Dimenslonsi Witl9t_T Length n Thick h -Christy Bol 7 Stove Pipe <br /> INP -SubmersibleC TurMne ❑OtMr HP Pump Set N Slanding Water Level T <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 CO SAT LAWS. <br /> MI 111- 4 R ADVANC TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9 -76,97 <br /> snPED TIRE PRESDIENT DATE s/7 <br /> e <br /> IIIRACE AFD <br /> AY 4 <br /> IN U� 1 � 201I <br /> F�IRpNM C�UNTy <br /> lTy pEPAR NT <br /> -i <br /> EpP` RTMENT USE NLY <br /> Application Accepted By 2%� •"' ate f AreeAtq1- Employee IDY. ,0 <br /> Grout Inspectbn By Dale ❑ SPECIAL We11 PerRlit <br /> Pump Inspection By Date ❑ WAIVER RBCONe(1 <br /> Soil Boring Inspection By Dale ConstNatM Well Depth R <br /> COMMENTS <br /> PE SC RsaNvstl CMekPI Amount Dab ParmiU Involcea WaRION <br /> Codas Info C h Remieed Semi.Rotuest Y <br /> Q P <br /> Er9♦1M 07/� weLLF PP91NIT <br /> uznx <br />