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Sep,20. 2011 11:25AM Canepa & Sons <br />WELL/PUMP PERMIT <br />No. 9699 P. 2 <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1869 EAST HAZELTON AVENUF - STOCKTON CA 66205 - (209) 469.9420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />SC Received <br />Into By <br />JOB ADDREBB 22403 N. CORD AVENUE cilrymp CLEMENTS, 95227 <br />AmountParrnitl <br />Remitted <br />CROBBSTREEY HIGHWAY 12 APN - - <br />02318 PARCEL SIZE 80.27 LAND USE APPLICATIONS <br />gervlee Request 4 Invoice B <br />OWWR NAME DITTRICH, CALEB & KALI PHONE(916)606-4443 <br />rx <br />OWNER ADDRESS POBOX263 CITyISTATE21P C CA 52 <br />CONTRACTOR CANEPA AND SONS, INC. PHONE (209) 532-1136 <br />q1ZM11 <br />CONTRACTOR ADDRESS 14364 CUESTA COURT CITY/STATEJZIP SONORA, CA 95370 <br />SVBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />I / <br />LICENSE Y C-57 f) C-61 7 D-09 _ Olner NUMBER 425749 SXPIRATIONDATIE 7I31�y6 <br />GEOGRAPHICAL INFORMATION' Coordinates Y Town,hio R.— R -1— <br />NTENDED USE = DomaslicJPrivele X Irrigation/Agncullural D Industrial D Water Quality Monilopng D Soil Sampling/Chareclerizallon <br />Public Water System <br />If tilnemnl from (MAar; y em ams on a one um er <br />,ve ur YyuHK 4. NOW wen - Heplacemenl well ❑ Well AlterallONModificalion U Other <br />_ MOnilOring Woll(5) 0 of wells U Soil Boring(a) s s of bori.yI l Gaotechnicel a a of bonne& <br />Out-Of-servlce Well O Out -Of -Service Well Renewal G Croee-Connection Repair <br />- New Pum . PUMP Replacement 11 Pump Repair n Relae Well Caslnn <br />Drilling Method X Mud Rotary - Air Rotary - Auger n Cable Tool fl Push Point r' Other <br />Proposed Well Depth 600' A Excavation 20" in diameter J Opan Bottom X Gravel Pack/Gravel Size 3 8+' in diameter <br />X Conductor Casing 24" Indlameler I Conductor Casing Depth 501 R <br />Well Casing Diameter 12 "In Thickness/GaUge/ASTM Sched .198 X Steel 0 Plastic D Stainless Steel U Other <br />Grout SeAI Depth 50' 4 U Nast Cement (94 lb bag/6-10 gel water) 4 Sand Cement 10.3 sack MiX17 gal waler <br />Benlonile (20% solids) U Other <br />Grout Placement Melhod �i Pumped u Free Fall Cl Other 7 Retardant / Accelerator (name) <br />PEQEbTAL Installed By L Driller 9 Pump Contractor Other <br />- Concrete Pedeataf-Dlmeneions; Width A Length R Thick In - Christy Box "1 Stova Plpe <br />PUMP _ SubmersibleC Turbine U Other HP Pump SeL-_ Standing Water Level fl <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BR 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 C04PENSATIONAtAWS. <br />Aj((t�tt1LA� IjU ADVANNOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) <br />SIGNED D(V� v ( _ - TITLE PRESOIENT DATE_ <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />EPARTMENT USE ONLY <br />Dale <br />of <br />Dale � Z <br />Date <br />Dale <br />M <br />0 <br />m o <br />Area9 / q J. Employee ID# SSG •r; �� <br />❑ SPECIAL Well Permit <br />0 WAIVER Received <br />Constructed Well Depth fl <br />PE <br />Codes <br />SC Received <br />Into By <br />CheckW <br />Cash <br />AmountParrnitl <br />Remitted <br />Dale <br />gervlee Request 4 Invoice B <br />Wall IDN <br />rx <br />1$0 <br />3 <br />q1ZM11 <br />WP00373,31 <br />EHD 43 -ca <br />4non9 O/ <�'�] WELL /DUMP Dennnr <br />Received Tlme Sep, 20. 2017 11:36AM No, 2334 (�� <br />