Laserfiche WebLink
r i <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 9S3-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOS ADDRESS ZOO y 3 CAreD(-ro N /¢-� CrrYlzlP <br /> p D <br /> CROSS STREET�16L1G!,ChQQOLYO 11 APN-A f S-130-VII PARCCL SIZE'_9 1)USE APPUCAT10N J/ O <br /> OWNER NAME !'(D EIQ T <br /> OWNER ADDRESS �QB�'I 'C/�-PrD4 ro N IQD C17YISTATFJZIPON <br /> CONTRACTOR CANEPA AND SONS, INC. pHom (209) 532-1136 <br /> CONTRACTOR ADDRESS 14384 CUESTA COURT CITYISTATEIZIP SONORA, CA 95370 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE21P <br /> LICENSE N C-57 0 C-61 3 D-09 -Other NUMBER 425749 EXPIRA71ON DATE 7/31/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> _INTENDEDU9E DomestwPrivate Irrigation/Agricultural Olndustrial DWaterQua it har gatlgn, <br /> Public Water System NED <br /> Ilublic Wale Owner: er ys em ame um <br /> TYPE OF.WORK New Well >(Replacement Well D Wap Akeration/Moditication 0 Other <br /> _Monitoring Well(s) #of wells U Soil Boring(s) aotbo 11�1T1'f1 {f,,�7.,t,Y,,t�'-F,!`3fottbJol Vsf� 1A�} l�} <br /> -Out- Service Well ❑Out-Of-Service We 11 Renewal 0Cross-Connec' aF'�"" ""F.v'r"V f1i1 oTJI <br /> New Pum -Pump Replacement n Pump Repair fflpleted of c l L d <br /> W_ELL CONSTRUCTION TiynE <br /> Drilling Method X Mud Rotary -Air Rotary -Auger n Cable Tool n Push Point bVC � 1 I 4 fl.,� <br /> Proposed Well Depth ft Excavation in diameter 7 Open BoUom Gravel PacklGravel ze 3 Iri d e <br /> X Conductor Casing.2&"_In diameter / Conductor DCasing Depth ��P ft <br /> Well Casing Diameter"in Thickness/Gauge/ASTM Sched� D Steel [15Plastic O Stainless Steel D Other <br /> Grout Seal Depth IM 1 ft U Neat Cement(941b bagIS-10 gat water) N$and Cement 11.3 sack rrrtxf7 gal water <br /> - Bentonite(20%solids) O Other <br /> Grout Placement Method X Pumped 0 Free Fall D Other 7 Retardant I Accelerator(name) <br /> PEDESTAL Installed By L Driller .X Pump Contractor Other <br /> -Concrete Pedestal-Dimensions:Width it Length U Thick In -Christy Box Stove Plpa <br /> PUMP -SubmersibteC Turbine 0 Other HP Pump Set U Standing Water Level tt <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 NSATION LAWS. <br /> M=1W 4 R ADVANC TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95 -76 7 <br /> SIGNED W11TLE PRESDIENT DATE �7 <br /> 9 � <br /> t CE�VED <br /> 4% 2011 <br /> ,L Y <br /> - I IV l E JOAQUIN <br /> Q /�p p��10UIV' <br /> F10 <br /> _{ — <br /> L �PRENTPE NLY <br /> Application Accepted By ate Are. Employee <br /> Grout Inspection By Date D SPECIAL W811 Permit <br /> Pump Inspection By Date 0 WAIVER Received <br /> Soil Boring Inspection By Date Constructs/dyvell Jepth ft /�n <br /> COMMENTS kle 1 f ilii A OVI C'45i'k—Lz � r� , liLf��r�� coir/! /L..I . <br /> PE Sc Received Check#/ Amount PermlV Invoice# Well IDO <br /> Codes Info Hy C h RemDate, Service Request# <br /> EHD <br /> 17-06 . D.--,� WELL/PUMP PERMIT <br /> U10117 <br />