|
INTLL f RUMP PERMIT N/
<br />*; SL'fd0\QLP CotN[V£>YIROS!fE', FAL HF.AL1n DLPARI VE+•r 60E+ -,i MAISSML-SIOChFU% CA 4$202^(209)36!;-:428
<br />! :VON -REFUNDABLE PLR311T EXPIRES 1 YEAR FROM DATE ISSUED
<br />Joa.iLaRF:c _— 1J�1—�J _l r L�.1"� _ 0 ClitiZte !r F � .3
<br />CROSSSIRYLI __y 1'1 r, rZ4 \J,
<br />;
<br />On\LRN\\lk - aIAAeOf
<br />'OWNER.ADDAE
<br />SL SCO,TMCTnA _
<br />APV V -A ? J 1
<br />©J,_-(_ t'ijY.Li F1ZiP_ t✓�,+LLC—I- � � T_, f
<br />-----
<br />$L8C0:\IK\CIUA �r1� '' 4
<br />LIC6,cF O C•S7 C•61 ❑ D•!.9 ❑ lT.6ar .l)IHE:tfi�L ! / Fy+tKL1lO, DL7E.— 5 _3
<br />GFocRtPLICU.I]}OR\,.IIO?: Cbnidinatel X _ F ionaship—_._ RRage Stolon--._
<br />T]3f TDEO C3E L'r O.mcs^r•Pri.zca Iregat;c.=.'Agnr tuna 13 LnduvAal GW'aur QkjMy%Icnitodng O Sc.l Samp:irr C!:ar„r:riRat`:cn
<br />TirFOlWo" 13Nzw%Vc11 ORep!=,ernt IV: 6C: e'i Alt: r; +:nr. l:c:',ii: •.ias OTcstfici: GQ:: -_r _ --
<br />O`.:at...,. ett'z;`isi------ _. - . ,... LiSoi!P.c .- ' --_..- _.. ...f��-t OG:c•.;xtc:c.!-- ._-.;...tr. --
<br />❑V,'dlih:-:r conA OO,,:Ai•Scr, ... .-9 ❑Oui-Of•Srni.c l5 -:•.I A: ... ...
<br />WELL CO.NYl RL M.
<br />Drilling Method O Mcd Rc:ary C] A!r RCtAry O Auga 0 C"";-- Toot E3 PA Pcirl i7 O:':. -r �
<br />Pro. powd Well Dap!", - R Euatatioa i5 dant:t:r
<br />O Open Bon on, i G Grai-I R%k ) Grdtei c;n i d!rrm :
<br />0 cendx0i Ca-"Xg lnd:.._, t C'ond:c'arCasingThy.h ft 1
<br />Will Casing tta. er
<br />❑ Plasir O Sta;ul:>s Stcr! O O:L; r 1
<br />Grnrat Seal C.- p h A ❑ N.al Ct to tag /S -IU ul'lx r+7
<br />O S:;ndC;x.rr :..c'. �•:i, i 7 ga! weer ,
<br />Gd_.�e; , (3.: s,.S.As) ❑SI_s:�c.ur..5+>z. _.oaA:�__
<br />J:z= _ _. ❑Spso:Ft'a OS>:.txS,.bo-ut.S
<br />Grunt Piaczroent Mob, -d ❑ ",i: vd O Fre F.:! O Cr., :r _
<br />❑ Rceard ? : Ac-ioWzr (rarr_)�
<br />PEDLSt:.L Ind Q ottl:a G ^ r.pcoslrac:cr
<br />❑Odin-.--------_^-.--
<br />[3 Cercrete Pedestal D!mensiont: l':.;;.:t — .l Le, th_
<br />'Poor
<br />ft Thick—is O CCrkn Box O State Pipe
<br />&r,.�-.z; �i,: IurY'r.: ❑Ofi:r _ HP_
<br />Fcrt:�Sd is S•a.:,i.r.;55'a::rLcc;i./'�{(i f.
<br />iVk t.L Ai.St el C1 \ Q OpCn m:Gn: L7 Gmv.' ,%—k
<br />Wo!S Diam..•,c---- i- Test t?eptSt—__ ft Dgwi to %%a+st
<br />---- _ it G C3,•ng to D: Perforate ti•,ra __- it to
<br />SezEn+,}Farerlat r+1,n CCmc1trr4 i9 hg. Sd(Igvl nakr) Dti3.IIC.rr.:;;._._.._._—_._rc4n;r:
<br />is:!aat.! D Bxs:ei_. P.i..n
<br />Q IF:rtn!1'L'i�':%i sC'SdS) Ct?siz*.:rfaamrrSp:c :i soltdc-_._. �:
<br />\am: __-._,—,-_ ❑Sites>on Fda OS,^•cs jt:5n-in.j
<br />Placement Method O rumpad ❑ Free Fall 0 o-�-:
<br />1 Cl COT,:,:, V. 1h',1;: t-owni C� + — _ �ti !:::o:t gr Q:
<br />❑ Completa to Evsting S::r(sca Pad
<br />t REREBt' CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND TRAY THE RORK WILL BE DOME IV ACCORDANCE AArtn NaN
<br />dOAQL)X COL'\TjrORDINANCES, STATE LAW5, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MV REQUIRED LTCE.NSE IS
<br />CURRENT AND ,WTA,E 1AIT1? TATE CALIFORN'fA CONTRACTORS STATE LICENSE BOARD AND THAT I A -At IN COMPLIXNCE WITH ALL
<br />Atp!ication Accep.W By
<br />Gx c: Tn=1E-cncn B)
<br />PJtra Tzip\Y.ica By
<br />D;:>:rLu;an Lcspeairct By
<br />Dtta - A:xaL..--- Fn�tcycxlD= Uml
<br />0 SPECIAL WC11 Permit
<br />Jz:t:so Y t t I FJ D WAIVERReceived
<br />Da+z Constructed Sl all Depth _._ h
<br />Phi
<br />It,
<br />
|