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Jun, 26, 2018 10:46AM Canepa & Sons No, 1917 P. 2 WELL/PUMP PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL, HEALTH DEPARTMENT 186B EAST HAZELTON AVENUE, STOCKTON CA 96206 •1209)466x420 NON-REFUNDABLE PERMIT CALL 209 963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDREBB 3 3 Ale CITY/LIP CROSS STREET�ftt��//��` �T^�sf N �/�✓ PARCEL SIzE f/" - —LAND USE APPLICATION is OWNER NAME id�'�7J,� ` 1 j'W ��/ ar � • � ' PHONE ^1,e,4, OWNER ADDRESS /VJ,,� H 1W, ,/ csc# Ly CITY/STATOZip �p"' - ; CONTRACTOR dA�v G,DA- PHONE /�� CONTRACTOR ADDRESS dMOSrA CITYISTATE/ZIP �'0'dR. < 740 SUBCONTRACTOR PHON1074p f •' �i (� �� SU9CONTRAc7oR ADDRESS CITYISTATEIZIP LICENSE C-51 ❑ C-61 it D-09 0 Qlher NUMBER EXPIRATION DATE DOMESTIC WELL SAMPLING: 17 General Mineral/Conform Bacteria (4391) U Dlbromochloropiapane (4392) D Arsenic (4383) INTENDED UBE ISIMMIX&V Irrigation/Agricultural ❑ Induslrial ❑ water Ouallly Monitoring D Soil Sampling/Characleritallon C1 Public Water System If ataarenl from Owner: WAlar syalam Nemo contect m6enA or Phona Number TYPEOe WORN New Well Cl Replacement Well D Well Alto reltonWodifiralion ❑ Other ❑ Monilofing Well(e) #ofwells U Soil Boring(s) 0 o bmin92 D Geolechnical xof borin" IJ Out -Of -Service Well n Out -Of -Service Well Renewal ❑ Cross-Connectlon Repair n New Pumo n PUmD Replacement U Pumo Repair 0 Raise Well Casing Drilling Method XMud Rotary U Air Rotary ❑ Auger 0 Cable Tool n Push Point ❑ Drher Proposed Well Depth 200 !: if Excevalion Z2 in diameter ❑ Open Bot m ❑ Gravel PacklGravel Size In dlamel �I Conductor Casing All in diameter / Condu for Ceain Depth fl H Well Casing Dlemeled='• in Thickness/Gauge/ASTM 3ehed D�xl�i ❑Steel Plastic ❑ stainless Steel ❑Other Grout Seal Depih SO R Leet Cement (94 Ib baglS-10 gel water) Send Cement ( sack mull Bal water ❑ Bentonite (20% solids) n Other OroulPlacement Method r Pumped Cl Free Fell D Other ❑ Retardant /Acceleralor(name) PEVI SM Installed By U DAller Pump Conlraelor I Other Concrete Pedeetat ❑Dlmenelons: Widlh ft Length ItThick in ❑ Christy Box 0 Stove PI e lum—, U Submersible❑ Turbine U Other HP PUMD Sel H Slending Water Level it I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS- I ALSO CERTIFY THAT MY REQUIRED LICENSE, IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL WORKERS C PENSATION LAWS, M HOUR APV 1= NOTICE REQUIRED FO NSPECTIONS - PLEASE CALL (2091,993-7697 SIGNED /A TITLE )WO.�W X N T DATE ` 1r Vc—eived Time °`Jun, 26 N D a P4 yk, a�® JUL 13 2013 H DqQU � pMFMTq Nrf' �RTMFNT EP�1 TMENT u�/4 aponcellon Accepted By Dale Area %Employee ID71_L� Grout Inspection By ale ❑ SPECIAL WAIT Permit Pump Inepaclion By Dale L7 WAIVER Received Soil Boring Inspeollop By Dale Constructed Well Depth R COMMENTS NMI ► cpm. �irv�� ME =1 �•:.�r�� 2 0 1 8 10.5 6 A M No -3768 5 ;- �U DV /,57�.� WELLIPUMP PERMIT