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WELL/PUMP PERMIT <br />SAN JO - COUNTY EwApowEMAL HEALTH DE►MTMEMT IM EAST HAaLTo% AVENUE - STOCKTON CA !6205 - (MI)4"-3420 <br />NON-REFUNDABLE PERWT CALL (209) 963-7697 Fat INsncTloNs EXPIRES 1 YEAR FRoM DATE 133L ED <br />.tom ADOREW 2021 E Flm Street (John C. Fremont EEIErllenaryr Sd=0 0,a, StoddonM205 _ I <br />CROW STREET Ward Avenue AM 'I �`0 <br />�_._. __PARCELit2t,�' LAMOUsEAnucATtoNi <br />OIMAR NAW Stockton Unified Sd wol District ptp� _ (209) 933-7000 <br />OWNER AWREsm <br />701 N. Madison Street <br />CONTACTOR Woodward Dripinq Co., Inc. <br />CONTRACTOR ADMSS oad <br />am. -.... <br />SUNCONTRACT�OR y�' eR., 'fes' <br />SUDCOUrRACTOR AOOMSII 1548 N. Maple Street <br />CRYrSTATElbp Stockton, CA 95202 <br />PHONE (707) 3744300 <br />CrTYISTATL'hP ftVWI 574` <br />R,�(9W}�10,.t1180 <br />ClrrrsTATE0P Corona, CA 92880-1783 <br />LICEIME txc-v CAI - Doi a Dew NttUMEK 710079 GIMRATIOM DATE <br />DOMESTIC WELL AAWLIMo: ! ; Cdww* Mklara C4Wm Badmtis (4391) 0 (4392) N WAC (4399) <br />Donvem kAhtale D Ire4mftVA0rk:u YmJ kduwtsl ❑ VAMw OuMb Mor*mrkv Sam -- <br />Public Wow SyNMI r7- <br />emow."6-0~ vissw N— Nw•M <br />TVM OP Wo Kc n Nmvr MIM L Repbo n wIt VAM WON AweegV1A0 11 D DENT <br />MordorkvWm%m)__ i orvw4 Sol Bo(ilp(s) merbomp x Gmowdxlkal3_eNW.erP. <br />Oul-0rServlcw VVA OW4X cwvjw WA Rwwwd O CIOW-CwwwcWn R" mk <br />Sing MeOlad D Mud Roery Air Rotary K Atgw U Cabe Tod Push POW C DEW <br />opo"d Wall Depth 20 A Encewbon 8 rock in dlwrrw D Open SON a GM491 PlIdrJGravel Size In <br />CmWucw Co*v------., in amm«w I Conductor Caskq DWVI _- It <br />Wk* CW e9 DMnww _ in THtluN /W/GMgdASTM Sdnd 081091 PeaYc StdnlaW SMd OI w <br />Grow t Seal Depth I p ` <br />It 'Y N.mt c.rtNnl (ar D eM�'S- ro pd R.bf� swd c.mMt--------- Mdt mirn <br />BeMoae +20% roils; Otw <br />Out ftcomim I Method Putped Free Fd rl OEM M,, o Rswftt /A=wwaw (nwm) <br />PEDESTAL kmmdW By n Draw Puny cw*acer DEW <br />Comm" pedesul oWwrAk N tAidlh 11 Lerplh R Thick ti Christy BOK SUM Pipe <br />r SLbmw ibis Tubww Otw HP Puny Set It Stwav Weer Leel R <br />I HEREBY CERTIFY THAT 1 HAVE PREPARED THIM APPLICATION AND THAT THE WORK WILL BE DONE KJ 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 1 AM IN COMPLLANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />M DV� NOPCE REQ IRE t R Q9)SO�F 69 <br />SlOwl) <2L <br />A M E N T U E ONky /�Vy�, <br />MPYraYon Acceped By A. _. i e 100 kky�r <br />GmtA n By pee SPECIAL WON POrtTlit <br />Pwm BY D WAIVER Rocolved <br />Soi BOrtnp Irmpedlar By <br />COMMENTS <br />Dab <br />Cmairmled Wei Depth <br />EfOai« �vl1 f VMLA\JIM ►E11Wr <br />