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Mar, 6, 2017 6 : 17AM Canepa & Sons No, 7851 P. 2/6 <br /> WELL/PUMP PERMIT <br /> I SAN JOAgUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1686 EgaT HAZELTON AVENUE-STOCKTON CA 86$06•(2(19)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> } N rn <br /> Joe ADDRESS _2125 SNYDER LANE CITyl21P STOCETON 95215 <br /> - a <br /> 0 <br /> CRO535TREET tVATERLOO ROAD ,,.p�APN 101-022-21 PARCEL SIZE <br /> j/��,/LI LAND1J�ys/�F,t A!w'QoWCATION tI T <br /> OWNER NAME ULLOA JOSE ^ Swum CD T. 14 t1 C0 �� AXV PjNNt (2uy) 298-3069 <br /> OWNER ADDR2SS 6650 WATERWELL WAY/11��"Te �. CITY/STMt' ' TRACY, CA. 95300 <br /> CONTRACTOR CANEPA AND SONS, INC. PHONE (209) 532-1136 <br /> CONTRACTORADDRE53 14384 CUESTA COURT CITY/STATEIZIP SONORA, CA 95370 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTAT2PLIP <br /> LICENSE X C57 G C-61 7 0-09 _ Other NUMBER 425749 EXPIRATION DATE 731/16 <br /> GEOrRAPHICAL INFORMATION: Coordlri X Y Townshlp_ Range Soctiorl_ <br /> IfJgty U UaE X Domaslic/Privals 7 hrgatlon/Agricultural p Indu.Irial C Water Quality Monitofing 7, Soil Sampling/Chareclerizaliun <br /> - Public Water System <br /> 11 CIIP_rom lrom vwnor: a er oys em ams an a ams or ono um <br /> TYPE OF WORK X New Well = Replacement Well c Well Alteration/Modification U Other <br /> _Monilorin Wu11, 4 or walla a Soil Borin o of Wrirp a or Wd.0 <br /> 9 (') 8(-) a Geotechnical <br /> OUi-Of-Service Well -1 Out-01-Sorvlce Wall Renewal 0 Cr089-Connection Repair <br /> - New Pum - Pump Replacement rl Pump Repair n Raise well casing <br /> IfyEl4 CoNBra UCT10N <br /> Drilling Method X Mud Rotary - Air Rotary -- Auger Cable Taol 7 Push PON '' 011w <br /> Proposed Well Depth 300' h EtteSvallon 12" In diameter Open Bottom X Gravel PacWGravrl Size--22 B" In diemeier , <br /> 2C Conductor Casing 16" In dismeter / Cenduclor Casing Depth to, R <br /> Well Geeing Diameter 6" in Thickness/Geug�IASTM Sehed ?tj Stsirt es• I fi Other <br /> Grout Seal Depth d49y/GG- It a Neel Cement(941D Degl5-10 get wale,) V Si G-_e.,, jsack mg17 gal waler <br /> Benloni(e(209b solids) a Oth6r <br /> Grout Placeme Method V,Pumped C Free Fall D Other Rolaraant/Accelerator(name) <br /> rA InslRllod By Driller 6 Pump Confrac(or Other <br /> -Concrela Podaitel-Dlmenslone:Width R Length h Thick In - Christy Box I$I-ye Pipe <br /> Subrri—ibli Turbine ❑Other HP Pump Set It Standing Water Level It <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 COMPENSATION LA <br /> M HOVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)96 -76 7 <br /> SlcueD TITLE PRESDIENT DATE <br /> T-TTT—F I 1777——1 1 # <br /> CEIVED <br /> I I I —## I Nk 0 (; ZOi <br /> PAYI L 13INRONW.NTAL W-ALT-h <br /> REG IT/SERW—ES <br /> d <br /> MAR � <br /> SAN JOA ' <br /> EHViR'` <br /> HEAL-�' <br /> A R M E N T 5 O N L Y / <br /> Application Ac ce pled ale `. Aroa � Employee IDN "(� <br /> Grout Inep iorf�.' �� Dale / 0 SPECIAL Well Permit <br /> Pump Inspection By Dale i] WAIVER Received <br /> Soil Boring Inspection By Date Conetructe Well De Ih ft <br /> COMM TS <br /> .?i <br /> PE SC Received Ch-.kA/ Amount Pei <br /> Codes Info Cash Remitted Dale SorYlce Ra user S Invoice B Woll IDA! <br /> 3 -) l-7 &F-0 1 <br /> S.� l4'S:4) 3 00 "•lam - ),% <br /> C 6 <br /> 77 �P � g <br /> En093'00 L-G�Ov/L(i- ����fLG/�4'-✓ /? OrO� l V�-� � ���}1J WELL rCIJI.^.?GEan11T Wr W C�'KG� <br /> Received Time NTar. 6. 2017 6 : 28AM No. 0945 <br />