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;,-i; Maar:, 27. 2017 12: 33OM Canepa & Sons Thal Scan Nc. 79;;9 F. 2 <br /> � �� Zn 3 <br /> WELL/PUMP PERMIT AV <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 EA5THAZELTDN AVENUE-STOCKTON CA 95205 -(209)468.342(1 <br /> NON-REFUNDABLE PERMIT CALL 208 963.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 8020 Waverly FOad .� ClydZip Linden, 55235 <br /> A <br /> CAOSSSTREET Shelton goad APN 093-4SO-05 <br /> —PARCEL SIZE 2OG.9LAND USE ADDLICATIONR <br /> OvMLRNAME California Materials Irlc PHONE 205 q7,1-7422R_ n <br /> OWNER ADDRESS PO BOX _231Q CITY/STATE/Z1P .St CCntOn, CA 9213 <br /> CONTRACTOR CANEPA APTD SONS, INC- PHONE (209) 572-1136 <br /> CONTRACTORADDRE9s 14'.84 CUESTA COURT CITYfSTATtl/ZIP SOVORA, CA 95370 <br /> SUBCONTRACTOR <br /> PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE x C-57 7.Col D-OS " Other NUkBER 925749 EKPIRATIONDATE 7/31/15 <br /> GEDaRAPHICAL INFORMATION: Coordinates Y Township_ Range SaCtlon <br /> IN1fN0ED UaE DOm6511UPllvale X Imgal!orJAgrlcullural ,i Industrial :-Water QUSI',ly MOM Loring I Soil Sampling/Characlorl el1on <br /> Public Weler System <br /> Ir 411fCKN Irp,n ame or e <br /> TYPE OF WORK X New Well - ROPlae6ment W94 W611 Alier2pcnR,1odl(Ic6110n Olhor <br /> .. MonAoringW6U(s) #of wells $oliBdin 1- aofoceNJs eofr,,n,q, <br /> g-) I-ieolecttnicel <br /> Out-Of-Service W611 (_Oul-Ot-Service Well Renewal L Cross-Connecllon Repan <br /> New Pum Pum qe lacemenl �'Pvm Reoalr fl Raisq Well Casfn <br /> WEL I_CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rclary Auger rl Cu51e Tool :I Push P-1 . Other <br /> Propoeetl Weil Daplh 0 _0 Excavation 20" md!ameler _Open Bctlom ��Gravel Pack/Gravel,^>q6__1Z e -dlamaler <br /> XConduclor Casing 24" n dl5meler / Conduclor Casing Depth 15' 11 <br /> Well Casing Dig—ler_10 i Thickness/Geuga/ASTM Sched .250 Steel F,P13-tiC SIaIn1696 Steel U Other <br /> Oroul Seel Depth �ft Nae1 Cement(84 Ib bag/5-10 gal Hefer) I Said C6menl neck mixt gal wa!- <br /> y Bonkrota(27,,4 solidi) .Other <br /> Grout Placement Method S Pumped G Free Fall !,Olher 7 Relardanl)ACcelefalor(name) <br /> PEDESTAL Installed By . Dr14& X Pump Conlrrclor Olt-er <br /> Concrete Pedostal-Dimensions:width h Length II Thick in Christy Boa Stove Pipe <br /> PI1fAP .. 51Jbmersih!e'_TurUina .:Other NP Pump Se! ft Sland ng Wal'r Leve h <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 A ACTIVEWITN THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS O €NSATI ON S. <br /> I 24 H U VANCE OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95 <br /> '76 <br /> SIGNED TITLE PRSSCIENT DAT L II/ / <br /> it <br /> Ei VV <br /> 2 7 201, <br /> F't•Y(f1ENj <br /> RECE�NjEIN /S IAL FIE 7}i <br /> f <br /> y>i Jo►au1NI FT-1 <br /> EM(1ROhP:. <br /> "E.-L-DEHE <br /> i- E P A RT ld E N T U((((//rr,�gggg�� E�QONLY F 7/�//Y7 <br /> Appicalmn Accepted B Date._.L Area_C� Em POyea <br /> DID7i� � <br /> Grout Inspeclio ale �. SPECIAL Well Perrnit <br /> Pump Inspecl'on By Dale G WAIVIER Received <br /> -1 <br /> SOA yetl.on y Dlt6 Conslrucletl Well Depth fl <br /> COMM T <br /> PE SCReceived Ch—h# Amount Data PO1rnt� Involcep WBII IDB <br /> Coag9 }nI'nr,fo,, By, Cuh Rvmlln1ed $aprvlGa Re uo�t$1 <br /> 9 <br /> EMO 43-oe /`t J Lv2ll poem.mq.m <br /> Jrnrw <br /> Received Time Mar. 27. 2017 12: �3PM No. 11C4 <br />