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Mar. 16. 2017 11 : 10AM Canepa & SonsI4No, 7910 P. 2/6 <br /> °,up. -h�1K� ccin -tT0hj <br /> WELL/PUMP PERMIT <br /> Y SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAf%tMENT 1 NO EA9t NAxEtTON AvENUE-STOCKTON CA 95305-1209)488,0420 <br /> NOWREFUNDAaLF PERMIT CALL{209 953-7697-FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBAopREss 28500 S, gird RiadCITvrztP,-jT*Cyr _55304 r� <br /> _.- <br /> CRGs3STREET W. Li.nne Road APN_'2S!-G20-64 PApcEL51ZE` AC LAND USE A0PL1CAhONN. <br /> OWNErrNAME Pet>, ere E Tr Tr P527-6209 Chuck <br /> OWNERADGRSSS 720 Dulaney P-venue Z26fu S rip CITY)STA. Y -40, FL 32801 <br /> CONTRACTOR CA-NEPA AND SONS, INC <br /> _ PHONE (209) 5J2-1135 <br /> CONTRACTORADDREea 14384 CUESTA COURT CITv1sTATEIZIP SONORA, CA 95370 <br /> SUBCONTRACTOR - PHoNf <br /> SUBCONTRACTOR AoorEa9 QITY7STATEJZIP <br /> LICENSE I1 C•57 ;.:Cbt D•G5 Othef NUMBER42574.5 E7(PIRATIONDATE 7J31/10 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y_ Township_ Range Section_,___„ <br /> BE OomasliclPrlvele r.,g i _,industrial t1 Water Ctuy'ity Monitoring i;9011 Ssmplirx,3rCharacterizatlotl <br /> Public Water SVyB!em <br /> If tlutercro!ran Q4nar, a nm yrw c. "s v, <br /> TyPEOFWORN X NOW Well RerUacemenl Wan ;;Wall AkeratiDNMoolfowion C Other <br /> Moniknring Walk%)__#of wells ,;SoilBdnng(s) scrbonrg: L;Geolechn.'Cal aorbv"a" <br /> Oul-Ot-Service Well f)put-01-Service Weil R6new9l 1 Cross•Cornedlion Repa r <br /> aW Ptlm "Pump R6 amanl i-i Purnp Repair Raise Well("m <br /> WEi�nN�TRi,. Iena+ <br /> Drilling Mathod X Mud Ro7ary Air Rotary -Auger Cable TOoi :!PUeh Point i' Other <br /> Proposed Weil Deptn 400' fl.- �Ex%evalion 12 ndiampier :;Open oitom ?COravalPecWGrTivelSize 3/8" Indiamater <br /> X GO,dUCtOY riaelilg in dauneier 1 Conducts Casing Depth It <br /> Well Casing Diameter "ti�4ac`1''4h'Ot"'st"GBuge/ASTrw Sch.d SDR21 Steel 1PIasGc 0 Hleinlas6 Steel '.1 Olher <br /> Grout seat D pfh I Neal Cement(94 lb bagl&10 99/watarJ _ick mrxn gal Water <br /> Benlcnite{A4,solids) Other <br /> GrourPlaceme athod XPumped ,eaFOII aOtna -1 Retardant IAccelerator(name) <br /> P n Tn, Installed By ,.Drfl15r X pump ConUrc',or Other <br /> Concrete Pedostal-Dimanslone:VVkM R Length R Thick In -ChrlatyBox '-stove Pipe <br /> Suhmwsible•Turb(na 03hsr HP -„�_. PumP Sk^(R Slandny WeWfleval k <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 13 <br /> CURRENT AND ACTIVE WITH THE CALIGORNIA CONTRACTORS STATE LICENSE aCIARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS PENSATION LAWS. <br /> d FlODVANtrH NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7s 7 <br /> SIGNED - — TITLE DATE <br /> I17- Fr7TT—F <br /> , <br /> i 1 <br /> - — <br /> l6 <br /> i <br /> Af <br /> Xr1 py, .v.,. <br /> T —#I#- <br /> M U E NLV <br /> Application ACcePted By._ Area _` Employtoe IDfr r � � <br /> Grout Inspeaicn By <br /> f Dam. SPECIAL W@II Porrnll Y <br /> Pump lnspecuon ey oats C WAIVER R®eelvad <br /> Soil Boring Ins elinn By Data _ .... Constructed W40 Depth ,tt <br /> COMMENTS <br /> IQ <br /> PC SC Received Chock#/ Amountermlu <br /> Codes Into B i�afk <br /> RwII d Defe ServiceRequest <br /> �111 Invoice WelllDO <br /> �t ((`` <br /> WELL,9UMPPEAMIT <br /> Received Time Mar, 16, 2017 11 ,21AM No, 1038 <br />