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Apr,26, 2018 9:11AM Canepa & Sons <br />WELL/PUMP PERMIT <br />No. 1355 P. 2/4 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTN DEPARTMENT <br />1668 EAST HAZELTON AVENUE - STOCKTON CA 95206 • (209) 4G8-3420 <br />NON-REFUNOAULE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />�[�� A� <br />Joa ADDRESS /AV 77 �'r/r'�T77►" /.Z� <br />CITYIZIP <br />�j <br />CROSS STREE IP % eV"`A < Ai APN � f' -do <br />/%� <br />PARCEL SIZE 141:i' <br />LANG IJ98 APPLICATION 4 <br />OWNER NAME�E,N�Fi L f <br />PHONE( - lo�,o NICK <br />//��/�i�'�y <br />OWNER ADDRESS IO P 14049d(y49d( 7ov�s <br />CITvIBrArEIZIP <br />CONTRACTOR /} O /V ,S / <br />i 2 <br />PNDNt(/r u 'a -J ;2 <br />CONTRACTOR AOOReas Zq �y C e Ir'/(!- `� <br />CITYISTATEIZIP �.4 3%27 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR AODRCSS CITYISTTATE/ZIP <br />LICENsR : 9p .! C-61 D-09 Other NUMBER��" 7 EMPIRATION DATe i <br />DOMESTIC WELL SAMPLING: 0 General Mineral/Coliform Bacteria (4391) C Dlbromochloropropene (4392) Lr Arsenic (4393) <br />INTENDED USE (Domesllc/Prlvale �rrigalion/Agricullural J Industrie) a Water Quality Monitoring I. Soil Sampling/Cbereclerizal ion <br />Public Water Syelem <br />IF diRennl from OWnOC Walar 8ydom Name Conlacl Noryo or Phone umber <br />TVPE OP WDRrc > New Well Replacement WellI Weft Alleralion/Modification Other <br />onlloring Well(&) kof walla � Soil Boring(s) I7ol Dorings rf Geolechnical 4 o oorfnp <br />:.: OUI-OI-Service Well -1 Out -Of -Service Well Renewal E CrOaS-Connection Repair <br />New Pum �: Plimp Replacement U Pv-p Repair RBlae Well Casin <br />WELL CONSTRUCTION <br />Drilling Method xMUd Rotary 7 Air Rotary i, Auger = Cable Tool t: Push Point C Other <br />Proposed Wall Depth R Excavation in diameter _1 Open Bottom ',V,'Grsvei Pack/Gravel Size in diameter <br />Conductor Casing in diameter f Conductor Casing Depth M <br />Well Caging Diamelor lt- In TMck fee s/Gaugo/ASTM Schetl . )R xEleel I Plastic Stainless Steel i Other <br />Grout Seel Deplh_j t o I Cj Neal Cement (94 ID 06g/5.10 get wafer) XSand Cement sackmlx/7 gal water <br />Benlonile(,,20% solid8) 11 Other <br />Grout Placement Method APUmpad .] Free Fall F Other C Relardant I Acceferetor (name) <br />DEErAL Installed By i' Driller ><Pump Contractor E Other <br />A Concrete Pedestal iDlmenelonx: Width R Length 8 Thick In -I Christy Box T, Stove Pipe <br />PUMP SuDmefelDla(; Turbine Other HP Pump Set if Standing Water Level It <br />I HEREBY CERTIFY THAT I HAVC PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />WJOAQUIN 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 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />OV <br />X <br />Y <br />EP,A TMENT <br />Applicalion Accepted By ale Area_�T�"' Employee IDtF <br />Grou(Inspaclion By Dale _ 1.1 SPECIAL -Well Permit <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />Date <br />Date <br />0 WAIVER Received <br />� <br />0 CF�VICtr; <br />qy <br />Constructod Well Depth tt %"oE,2&4 <br />y ?018 <br />E O"UN C <br />OFP 'ACTh &4y OU/VT- <br />et Q Invoice ID fi • 7 <br />'qRT/ y�HT <br />!�p���.�il�.�/1llti�i <br />I�R�III�I• .zLAL <br />ENO e�cc ra�lceU 4114118 8fJ 457q / WELL !PUMP PERMIT <br />�5Rte`c-eeived Time Apr, 26, 2018 9:21AM N.o, 3423 <br />�'A <br />