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1 Mast. 27. 2017 12: 33'M Canepa & Sons �iha1 SCS No. 7989 P. 2 <br /> WELL/PUMP PERMIT <br /> ja�7- //.�'1 - SAN JOAOUIN COUNTY ENVIRONMENTAL NeALiN DEPARTMENT 1069 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)488•]420 <br /> ( !/ NONREFUNDABLE PERMIT CALL(209)963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> I JOB ADDRESS 8020 Waverly Road CITY2IP Littl 95236 <br /> p <br /> v <br /> CRQ459TREE7 Shelton Rodd APN 093-450-05 PARCELs¢E 200.9 LAND USE APPLICATION r+ v <br /> CviNCnNAME California Materiels Inc. _ PHONE 209 972-7422 Ron <br /> OWNER ADDRESS PO BOX 32314 CITY+8TATE2tP Stockt On, CA 95213 <br /> CONTRACTOR CANEPA AND SONS, INC. PRoNE (209) 532-1136 <br /> CONTRACTOR ADDRESS 14384 CUESTA COURT CtTY/STAT>!21P SONORA, CA 95370 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STAlE21P <br /> LICENSE X C•57 C-el `.D-09 -.Other NUMBER 425749 EXPIRATION DATE 7/31/16 <br /> GEOORAPNICAL INFORMATION: Coordinates X Y Township_ Range SaCilon_ <br /> I/lTENoeD USE Domealle/Privele X Irrigallan/Agrieuliuml 1 InduaVlal ;'.Wale OUSII(y Mon Loring ;I Soil Sampling/CharaclarizaUon <br /> Public Water System <br /> Iraltarom(Cm Wner er sem a o aFame a PlIfItne rqrjmtmr <br /> TYPE OF WORK X New Well - Replacemenl WeN -,Wall Alieralian/MOd fIcslbn I.Othar <br /> ..Mon,lonng Wells) of wells I.Soil Bonin aor Penngs eM6adng- <br /> _ 0(�) I�GeoleChnical <br /> Out-Of-Service well i:Oul-Of-Service W611 Renewal 1i Cross-Connecllon Repair <br /> - New Pum "Pum Re lacemenl Pum Reoav fl Raise Well CBEIn <br /> WELL CPNBTRUCnoN , <br /> Drilling Method X Mud Rotary .. Air Relary -"Auger iii Cable Tool -I Push Poiro r Other <br /> Proposed Well Dap!h 500' D Eycevetlon 20' In d4nelsr -Open Bottom X Gravel Pack/Gravel Size 3/8" in diameter <br /> X Conductor Casing 24" ndlsmeler I Conductor Casing Deplh 15' fl <br /> Well Casing Diamater_j0 In ThicknesstGsuga/ASTM SChed .250 X,Steel 11)Plastic 71 Stainless Steel U Other <br /> Grout Seel Depth_ ft Nest Cement(84 10 bag/S-10 gal weler) I Sand Cement s5ck mix>i gel water <br /> Y.Banlcnite(20°�G bolltla) ;i 011wr <br /> Grout Placement Method g Pumped C Free Fall U Other J Retardant/Accelerator(name) <br /> prQrSyL Installed By ,.Drl9er X Pump Contractor Other <br /> Concrete Padostal-Olmenalona:W dth_f( Length R Thick n Christy Box i Slove Pipe <br /> Submersibles_Turbine .!Other HP Pump Se' fl Slanding Waler Leval h <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 ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS 0 €NSATION S- <br /> I 24 H U�VANCEE REQUIRED FOR INSPECTIONS PLEASE CALL(209)eS -76 <br /> SIGNED TITLE PRESDIENT ED)AM / <br /> EIVEt) <br /> 1 7 20v <br /> PA`��tENT <br /> P.EGEIV E IAL FEAL7}i <br /> EN 1W 15ER CES <br /> Latr� <br /> �e- <br /> EPARTMENT U E NLY f�/''1 <br /> Appicalmn Acceplad B Oete Area EmPoyee IDs ( L V <br /> Grout Inspecdi Date E SPECIAL Wall PerMit <br /> Pump Inspeclion By Dale 0 WAIVER Received <br /> Sol( lion y Date Conbtrucled Well Depth n <br /> COMM <br /> PE SC Received CftacYtT/ AmOunl Dats Permit/ InVOICe R Well IDS <br /> Codes Info B Cash Remitted Service Request tl <br /> 001 0 <br /> 1rnr.gno as Pe D/^ wQ(lR No eEaNlr <br /> a <br /> Received Time Mar. 21. 2017 12:43PM No. 1104 <br />