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00,'25,1 2079 Ol;57 Canepa & Sons (FAX, P.004/008 <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1888 EAST HA2ELTON AVENUE-STOCKTON CA 95205-(209)488.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoeAODltess 1_5"?i07OS s.' ChYtZIP <br /> I �/t d r• ��. a <br /> '2 GRO935TREET 616 �S° 1�, 1116 'l"? APN��V'✓�"�'- V Ce PARCILS1ZG�LAND(�3 PPUqTION# <br /> W v^` OwNER NAME "Jv 6��/S I'W Y,/Le LJ6� PHONIInq <br /> •� t <br /> l n11�!r/�� �� LL'' f <br /> / �ADDREsa ✓�'i r3/7 rUJ�S ,•' il,J CIT,/STATE0P <br /> CONTRACTOR CANEPA AND SONS,INC, PNONe (209)$32-1136 <br /> / CONTRACTOR ADDR913 14384 CUESTA COURT CrTY/$TATE/7JP SONORA,CA 95370 <br /> ys ' 1 SVUCONTRACTOR PHONE <br /> ADDRRSSCITY/STATEI7JP <br /> ZiaCONTRACTOR <br /> ENBE INC-57 D C-61 D D-09 0 Other NUMBER 425749 EXPIRATION DATE 7/31/2020 <br /> i I <br /> goMEamc WELL SAMPLING:0 General MlnersVCollfarrn Bacteria(459 1)0 OlbromochlDropropane(4392)❑Arsenio(4383) �/S Y <br /> INTENOt:e U!m D DomeeticJPrivate m I <br /> ntgation/Agricultraral [7 IndusMol D Water Quality Monitoring D Soil Sampling/CharactedZZifion ��^^11• M�r <br /> ❑ Public Water Sys;e <br /> (��,{/ If difrerenl Rem 0-psn ator 6yewm N'tmo Contact Noma or a66nY Nttrnbor (+ <br /> ' T PE OF WORK TIaW Well $Zeplacement Well 0 Well Aiteratlon/Modifieation D Other <br /> 0 Monitoring Wcll(s) Aorwells O SollBoring(S) aOrhodngo 0 Geotechnical ecfWing- L� 9 <br /> 11 <br /> 0 Out-Of-Service Udell 0 Out-Of-Service Well Renewal D Cross-Connection Repair ✓Qq �0/9 <br /> D Newpurnp 0 Pqmp Replacement 0 Pump Rc air 0 Ralsc Wcll Cavin FHS QV/ <br /> s c oN STN p0HN V UHC' <br /> Drilling Method AMud Rota.ry D Air Rotary D Augcrr��j0 Cable Tool 0 Push Point 0 Other Fp�14 <br /> Proposed Woll y.Dcpth�ft Excavation 240 In diameter 0 Opcn Bottom )r1travcl Pack/Oravel Size 3 in diameter FHT <br /> �i.Conductor CesinO � indiameter t COnducter Casing Depth 60 ft <br /> Woll Casing (Diameter_J_�&In ThIftess/Gauge/ASTIA Schad )(Steel 0 Plastic D Stainless Steel 0 Other <br /> Grout Seal DepthjXjo�H 0 Neat Cement(84 lb bog15.10 98/watet) Kand Cement to, sack m1x/7 gal wator <br /> 0 gentenite 20%solids) 0 Other <br /> Grout Placement Method Rumped C Free Fall 0 Other p Retardant/Accelcmtor(name <br /> PEDEBTAL Installed By 0 Driller Pump Contractor D Other <br /> C Concrete Pedestal Obf ensions;Width ft Length RThI& In C Christy Box D Stove Pipr— <br /> Pump <br /> 0 SubmersibleD Turbine 0 Other HP Pum Sat R Stan WaterLevcl ft <br /> I HEREBY ct=RTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL 9E DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> M 1lM 48 HOUR ADVANCE NOTICE REQUIRED FOR.��,•NySPEGTIONS-PLEASE CALL(209)9§3-76P7 <br /> TITLE ® !L�"�•/��tJs DATE �l <br /> v o <br /> TT <br /> y <br /> P A M E N T U E JDNLY <br /> Application Accepted By ate AreeaFmpioyee IDs <br /> Grout Inspectron By � Dote 0 SPECIAL Wall Permit <br /> Pump Inspoction By Date 0 WAIVER Received <br /> Soil Poring ImmeLeon By to-- Constructed Well Depth tt <br /> COMM NTS 10 - ? yv0`U J �(✓ e � � '� �r�d � <br /> III � cry �D�Y /®-®'t{ --7 Z - <br /> PE SC Received Check#/ Amount Permilf Invoice 8 Wc11 IDO <br /> Co es ash RemittedPAC) Service Ro ucstO <br /> I <br /> Received TimeTSep. 25. -2019_ 7 ; 58ANI_No, 5528 <br /> PMD 0,0e(4v1*4 4/1411a —ff 96(,/)2-71 -- WELL(PUMP PERMIT <br />