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11 <br /> WELLIPUMP PERMIT <br /> SAN JOACUIN COUNTY ENVIRONMENTAL HEALTH[IMPARTMENT 1869 EAST HAZELTON AVENUE-STOCKTON CA 96208-(209)468-5420 <br /> NON-REFUNDABLE PERMIT CALL 12091963-7697 FOR INSPECTIONS EXPIRES 'I YEAR FROM DATE ISSUED <br /> rn <br /> JOE ADDREBS 24725 CIOUGH ROAD CirvlZip ESCALONr CIT 952.20 p <br /> 0 <br /> CROS13STREET DARLIN POAD APN 247-130-21 PARCEL SIZE AC LAND USE APPLICATION# <br /> OWNER NAMESAVAAO, ZOR,Z LYNM PHONE (209) 484.-1010 NICK -`"- <br /> OWNERADDRBSS 20102 DART.�TN .ROAD CITYISTATF/Zlfl„Z�-cALOtd, CA GS?2G <br /> CONTRACTOR CANEPA AND SONS, INC- PHONE (209) 532-1136 <br /> CONTRACTOR ADDRESS 14384 CUESTA COUPT rill Mill a <br /> iT, 0 0 q CP. 95370 <br /> SUBCONTRACTOR <br /> SUBCONTRACTOR ADDKESs M�l �1 CI)TYYIIiSTAATEEIIZIP r1 <br /> LICENSE M C-67 _1 C-61 0 D-09 _. Other Ermit rlpl4fytPAWAX 'II�eIi Wj 7/31/16 <br /> GEOORAPHICALINFORMATion: COordinate*X v,1 b t Section_ <br /> IN7ENDm lice DornealIc/Private J Irrigatlon/Agrlculwrel p I dpi al t'L,1,water Quality I t Orin LI f,. 11 ugmgltngrCherecterization <br /> - Public WaterSVVst�eBm � ►�It fl'1C1"t�ii; � <br /> I/Gitreront Rom O�4ne,! r-— . . <br /> TXPR OF WORK MCW WBII X Replacement Well D Well ARerallon/Modification [I Omer <br /> MonitoringWell(B) 90fwell; t.1 fioll6oring(a) 9or60n°R° tl GeOledinical Nofboom;: <br /> Out-Of-Service Well CI Out-Of-SeMCe Well Renewal 0 Gross-Connection Repair <br /> New Pum " Pump Replacement n Pump Repair I Raise Well Casln <br /> WELL CONSMUr,TION <br /> Drilling Method ,v,bAud Rotary "-A.irRotary -Auger rt Cable Tool M Push Point - Other <br /> Proposed Well Depth 300' it Excavation 15" In dlameler _,.Open Bottom ).5 Gravel Pack/Gravel Size 3/8„ In diameter <br /> .-Conductor Casing In dlemetef / Condu;.tor Casing Depth ft <br /> Well Casing Dlemeter-.L' in ThlckneWGaugeIASTM Schad L 25 D X Steel L Pla,tic O Stainless Steel D rJlltar <br /> Grout Seal Depth'ift fl U Neat Cement(94 lb oagIS•10 pa/watar) Sand Cemen>` sack ,,,(7 gal water <br /> X Benwrine(20%solide) 0 Other <br /> Grout Placement Method S Pumped .-Free Fall n Other_ J Retardant/Accelerator(name) <br /> PEDE-TAL Installed By L DEller S Pump Ccnlmclor Other <br /> Concrete Pedestal -Dimensions:Widen ft Length ft Thick in - Chrlsty Box -I Stove Pip- <br /> -punt" ';„Submersible_Turbine C Omer HP Pump Se! ft Standing Water Level ft �1 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN A`lyM <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS REQ �"VT <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL % ,I v <br /> WORKERS PA <br /> C SA71ON LAWS Nov <br /> M I U �9�ANCE N TICS REgUIRED FOR N PE T1' -tPL SE CALL(209)953 87 <br /> 61ONEO-lk TITL DATE - Q Fq"?0Q�MNO41 o1J <br /> a \00 <br /> � <br /> CEIVED <br /> ov 2 0 2015 <br /> ONMENTAL HEALTH <br /> RMITISERVICES <br /> - C IOLG <br /> DEPARTMENT <br /> �USE <br /> ONLY 7///'y///1(� <br /> AppllcatiOn Accepted`By Delete Area Employee IDX <br /> Grout Inspection By Date 1 , I. SPECIAL WAII Permit <br /> Pump Inapeollon By Dale E WAIVER RACoiVad <br /> Soil Boring Irupecllon By Date C nstrttcted Well Depth ft <br /> COM ENTS �� n (, �r <br /> s <br /> PE SC ROCejye CIIeCxN/ Amount f Parent <br /> Godes roto 6y Cash Remitted Date service Re uest# 1 ogee* well I # <br /> u � T WELL(PUMP PL°QMIlr <br /> Received Tinm'ereD/Nov, 20. 2015 1 : 56PM No- 0056 �c Y7 T <br />