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PA`s <br />REQ <br />WELUPUMP PERMIT C " r <br />SAH JOAQUW C UNTY EHylRar0W'N TA - N6ALTH DCPARTrexr I N8 F-4= NAZKM AMIE-SIOOROM CA S&W - (M) 499 -SM <br />NON-REFUNDABLE PERMIT CALL 209 953-707 FoR HAbPeCTIOM r @MM 1 YEAR FROM DATE 1651.IE0 <br />����nU�l iivG CG <br />GEOGRAPWCAL IW-OMATION: Ceerdet d" X y Town2 b_ R>1tIQ! 3ecdw_ <br />waroom Use lml98ftVA7kAAJW Indl.Mft Water QUBRY L4*f trg Sd <br />Pubk System <br />E ratm d. <br />TYPE OF Wows New W e0 Reptaownent Wei Wel AfterabwAAoMcabon OMer <br />hADwido ing Wed(Sa Of weft Sod B—Q(s) `d . Gaawaincel e°rWdrg. <br />--Of----r %yu Out-0fSenite Wag Renewal cmaa.C� now <br />New Pmp V Pim t Pwv PAPar RIPOIG W <br />'Yrci� C.b�aTRUCnOrr <br />Orilfop MethodM RobExcavarim Auger Tool Ptah Port Od9er <br />Proposed We0 Qeptn�ft _� drameter Open 9ortom Qatel Ped"Byel Sae im Baereler <br />Gado= Cacng in dtanteaer , Cordu= Camp Depth 0: <br />Well Cawng D4meter _ m Tnmo,essroal MSTM Schell stow Pl.afie SI k*m Stec Cle <br />Grout Seal Deph _ft Neat Cweent 194 6 bey pro gel wrier) Seed tact nwd7 gal w mw <br />Bartmnae (20% solids) o0t� <br />Gran PheeffwA Madiod Pteneed Free Fell Other Rwwdwrt! 0-2 No A'tw s) <br />Cormwate Pedesbi Okwasicaw Width _ ft LanglhIt ThI* Boz : - 3bw4e <br />r_rlawo SuDrt,ersible Turbine Odw HPL14Pimp R Walar L&4 ft <br />I IE <br />REREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THAT THE WORK MILL BE MW N ACCORDANCE MATH SAN <br />JOAOUIN COUNTY ORDINANCES. STATE LAWS. AND RULES AND REGULATIONS. I AL,YO CWWY VW MY IMMED D LICENSE S <br />cuaReN r AND THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM N COMPLIANCE 1AllT1I ALL <br />WORKER$ LAW4, <br />MINIM MOURSDdANCE NOT)CE REQUIRFjD,FPf0SPE,CT10= - PLEASE GALL (=9L. -43-7W7, <br />S+GaED '-i B. 4 �-� T)J J -fly V! (It W (V I. DATE -t I L <br />Sr^ ZOl(t EPARTMENT USE ONLY <br />r �+ <br />APPW Ww Accepted sy ❑are / �' . ( ) <br />H J.pAQLI'' <br />SAE�I� gout Inspectiart BY Date <br />inapemon By D -w 0 1 oy <br />Sal Bonny Insvecion By Dem <br />He <br />�r iV <br />SEP o 5 2017 <br />Ati `i `�` ert,py,e MOR A hrM ( G� <br />SIAL VM Penna <br />%V* IM Rocwvetd <br />Oereelauai - I" Det R <br />HEALTH <br />rz e.�,wK- ULtct <br />LIsyl <br />11. <br />I <br />