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Jul, 31. 2018 8 : 04AM Canepa & Sons No. 2341 P. 2 <br /> WELL/PUMP PERMIT <br /> -• SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 EASTHAZELTON AVENUE-STOCKTON CA 98205 -(2091408-3420 <br /> NON-REFUNDABLE PERMIT J CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED V <br /> Joe AooREaB /5'079 X- AfWA14)r Z, CITYIZIP Lao/ <br /> o A <br /> C9055 STREET I V/. APN o53 - PS/PARCEL Sr�E -LArro UgE APPLICATION tl <br /> OWNER NAM / <br /> E •14J rp e �A/TK PQ I S <br /> PHONE��u7�V4 <br /> � <br /> OWNER ADDRESS /,1$9 IS"I Ar` r/eRP _ CITY/STATE/ZIP X e14- <br /> CONTRACTOR <br /> .d/T-CONTRACTOR CANEPA AND SONS, INC. PHONE (209) 532-1136 <br /> CONTRACTOR ADDRESS 19363 CUESTA COURT CiTYISTATEIZIP SONORA, CA 95390 <br /> SUBCONTRACTOR PHON2 <br /> SUBCONTRACTOR ADDRESS CITY/STATEIYIP <br /> LICENSE 1(C-57 L C-61 .i 0-09 _ Other. NUMBER 925999 EXPIRATION DATE 7331�1a <br /> GEOGRAPHICAL I NFORMATION; Coordlnales X Y Township` Range Section_ <br /> INTENDED(l " DOrrleeli6/Pfivglo X IfflgallonlA3ficullural El Indu6trIal G Water Quality Monitoring r3 Soil SamplingrChsraeleri:a(ion <br /> Public Water System <br /> Irdttomrl from Owner: ser ya em oma ams or one um <br /> TYPE OF WORK X New Well - Replacement Well IJ Well All eral lorVM,3dificolion l-)Other V PA Y41 <br /> _ Monllorin Well'- 4Of Wells ,J Soil Bcrn Nor DoriAV i_ Nol r»n ng, <br /> 0 l-) i g(s) Geotechniol c <br /> Oul-Of-service Well :;;Out-Of-Service Well Renewal 0 Cross-Conneclion Repair CF V <br /> New PVn1 Pump Re laramenl f.Pum Re air n Roiso Well Casln <br /> YYELL CONSTRUCTION <br /> Drilling Melhod X Mud Ro^tta^r�y -" Air Rotary -Auger 7Cable Tool n Push PoInI " Other � <br /> 13 18 <br /> Proposed Well Oaplh-1 Q) 11 Excavation 20" in digmelor -)Ope^Aollom ?�Gravel PacWGrsvel Size 3/8" In diem DU <br /> A O• <br /> XConauclorCesing :9" ndiameter I Conn-!;(grr�Sing0 th fl IH <br /> Well Casing Diameter 1-in Thleknese/Gauge/ASTMScheo,.ZSO Steal �PISAIC 0 S(ainlessSteel 11 Other E NN <br /> Grout Seal Depth.!�POfl Nee(Cement(9d Ih De9/S70 gal wsf rJ 6 Sand Cement 11-3 sack mixl7�I�r <br /> Benlcnitu(2090 solids) L: Other NT <br /> Grout Placement Method X Pumpod C Free Fell a Other :1 Retardant/Accelerator(name) <br /> PEDESTAL Inslallod By Ofll6r Pump Contractor Other <br /> Concrete Pedustat-Dimensions:Width ft Lenglh fl Thick In -Christy Box _ Stove Pipe <br /> PUMP - Suomerelble..:Turbine ❑Other HP pump Sel fl Slanding Water Level fl <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORN 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 /> VjrOR EL jCOMPEN ATION LAWS. <br /> �/� <br /> MINIM R ADVANCE NOTIC EDUIRED FOR INSPECTIONS-PLEASE CALL(209)859-769 9 <br /> SIGNED TITLE PRG DI ENT DATE f+ <br /> Et <br /> P A T M E N` U 1 I <br /> lz" <br /> LL <br /> ou <br /> Application Ac-opted By Dale Area Employee ID0 <br /> Gfl Inspeclian By �� Date ❑ PECIAL WAIT Permit, <br /> Pump In5p6ctlon By ✓� t Oals ❑ WAIVER Received /p <br /> Soil BoringIn ecuon lr/ <br /> ,,�y y Da16 Constructed Well Depth fl <br /> COMMENTS C :2 <br /> PE Sc R...1—d Chpckrf/ Amount Pafmltl <br /> Dale Involce N Wall IDN <br /> C6de5 I fo B Cosh Remitted Service Re uoel k <br /> END o7,J8 / <br /> WELL 1PUA1P PERMIT <br /> Received Time Ju1, 31, 2018 8 . 24AM No, 3944 �� <br />