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WP0041929
Environmental Health - Public
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EHD Program Facility Records by Street Name
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5167
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041929
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Last modified
11/28/2023 11:14:40 AM
Creation date
11/29/2022 11:16:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041929
PE
4369
STREET_NUMBER
5167
Direction
N
STREET_NAME
WAVERLY
STREET_TYPE
RD
City
LINDEN
Zip
95236-
APN
09336001
ENTERED_DATE
4/15/2021 12:00:00 AM
SITE_LOCATION
5167 N WAVERLY RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\gmartinez
Tags
EHD - Public
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i ` <br /> �!.. gfe S�3I lC,clt <br /> eC <br /> �...�..a ..... /Yl„ ./s __. .,. „O ,�.✓„-i1,d�/ii _,�� ^.•.A�_ „//., a .�.oh����a. ,,;,r-..ila <br /> Depth from I,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 /> .-- 07 500 12.25 <br /> 14384 CUESTA COURT SONORA CA 95370 <br /> Address City State <br /> Signed electronic signature received 11/18/2022 425749 <br /> C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> 1,/„! ��. <br /> CSG# State Well Number Site Code Local Well Number <br /> N W <br /> Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br /> TRS: <br /> APN: <br /> Form DWR 188 rev. 12/19/2017 Page 3 of 3 <br />
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