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WP0042818
EnvironmentalHealth
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HARNEY
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042818
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Entry Properties
Last modified
1/31/2022 2:14:38 PM
Creation date
12/30/2021 11:24:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042818
PE
4373
STREET_NUMBER
130
Direction
E
STREET_NAME
HARNEY
STREET_TYPE
LN
City
LODI
Zip
95240-
APN
05813025
ENTERED_DATE
12/8/2021 12:00:00 AM
SITE_LOCATION
130 E HARNEY LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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,Boehote Ica 10 ` , ;erti°ation,S aieinent` <br />Depth from 1, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Surface Borehole Diameter (inches) Name CANEPA AND SONS INC <br />Feet to Feet <br />Person, Firm or Corporation <br />14384 CUESTA COURT SONORA CA 95370 <br />Address City State <br />Signed electronic signature received 12/28/2021 425749 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />CSG # I State Well <br />Latitude Deg/Mi <br />TRS: <br />APN: <br />Site Code <br />Local Well Number <br />FW <br />Longitude Deg/Min/Sec <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />
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