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Ma r, 16. 2017 11 , 10AM C a n e P a & SonsNo. 7910 P. 2/6 <br /> '.h`�kl�� � Can 7 phis <br /> r• <br /> WELL/PUMP PERMIT °214"l,'% <br /> SAN JOAQUIN COUNTV ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> Y NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBAODREas 28960 S. Bird Road CITU/ZIP TraCy, 95304 <br /> CROSSSTREET W. Linne Road APN 255-020-69 PARCELSIZE 5 AC LAND USE APPLICATIONN <br /> OWNER NAME Ptitz. LeroyE JrPHONE 6211-62 -`" <br /> OWNERADDREsa 720 Delaney Avenue�'Lg2(/u .S ���� CITYISTATEIZI r nc(O, FL 32801 <br /> CONTRACTOR CANEPA AND BONS, INC. <br /> PHONE (209) 532-1136 <br /> CONTRACTORADDREaa 14389 CUESTA COURT CITY181 E/ZIP SONORA, CA 95370 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCONTRACTOR ADDRE88 CITYISTATE(LIP <br /> LICENSE N C.57 C:Cbl :.;D-09 '_Other NUMBER 425749 EXPIRATIONDATE 7/31/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section <br /> aE OOMPSUC1PFIV61e rng al G Industrial (')W8lerQuelilyMon6oring (::Boll Sampling/Characterization <br /> - Public Water System <br /> If dillerenl rrorr�OJ,nar: em ams p <br /> ne um er <br /> TYPEOF WORK X Naw Well _ Replacement Wetl Wall AlteralloNMOdITiCalion U Other <br /> MonlloringWeil(s) #Of wells n Sail Boring(*) aorborngs i1 Geolechnical Norbarirge <br /> Oul-Of-Service Well I;Out-Of-Service Well Renewal U Cross-Connecllon Repair <br /> New Pum 'Pump Replacement Fii Pump Ra air it Raise Well Casm <br /> W ELI_CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rotary "Auger Cable Tool i I Push Point I' Other <br /> Proposed Well Depth 400' h xcavallom 12" In diameter _]Open ollom X Gravel Pack/Gravel Size 5/8" In diameter <br /> X Conductor Casing W In diameter / Conduclor Cesing Depth R <br /> Well Casing Diameter 6' I Thlckn slGauge/ASTM Schad SDR21 31ee1 '1XPlastic D Stainless Steel '.1 Other <br /> Grout SealgDplh�1I :.:Neel Cement(94 ib bag/5-t0 gel wafer) sack mlxr7 gel water <br /> Benloni1 (20 a solids) is OtheGroutplacemeethod X Pumped U Free Fell :,Other 1 Relardanl/Accelerator(name) <br /> PUF5rAL Installed By i. Dnller 24 Pump Contractor Other <br /> -' Concrete Pedestal-Dimensions:Width 11 Langih fl Thick In -Christy Box "1 Stove Pipa <br /> PUMv ..Submersible" Turbine i':Other. HP Pump Sel fl Standing Water Level fl <br /> I HEREBY CERTIFY THAT 1 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 PE14SATION LAWS. <br /> 4 HO DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)96 -76 7-1 <br /> SIGNED TITLE FRESDIENT DATE: 1 <br /> VE <br /> R 16 ?01/ <br /> Mid <br /> PAYS' <br /> RFCF� <br /> 51�H JO An fN <br /> O <br /> E -,R Epe,P E. <br /> I" E P R TMENT U E N L Y <br /> .tEA . <br /> Application ACCeDIed B I Oal Area Employee IDg�� f VW <br /> Grout Inspeclion 8y Dale i'; SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Bering In action By Dale Constructed Wall Depth ft <br /> COMMENTS( �' r L <br /> O Gr -,LAV Al <br /> PE Sc Reoelved CheckRl Amount Data Permit/ Invoice a Well IDN <br /> Codes Info B ash Remitted Service Ra uesl tt <br /> ,ESw12d " 3 22 &R-00-7 7 001) D Z <br /> END'd06 / / WELL/PUMP PER MIT <br /> Received Time Mar, 16, 2017 11 , 21AM No, 1038 (�!/ <br />