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WELLIPUMP PERMIT Q/ C <br />SAN J --lm C xwTy EJ IVIR mwmTAL Hsun+ DePArsnlen 18M EAST KAMM A6aE •SIOCiTCM CA>13206 - pes) 96&3420 <br />NON ZEFUND eRr E PERMIT CALL 209 963-7697 FOIL WSPEOfl m 1 YEAR FROM DATE'-----, <br />111-4 <br />�Joe s.....Fa< <br />CRosS STr APR <br />t% ' A1RC2L . w uw 1AR 1 O <br />ot«�n N.urC GcUPI on(( <br />CONTRACTOR[ _ - u �'S.e �'J �M.17'► S 6D1- L 4 A P -m <br />CONTRACTOR ADDR=LA (( CmrarA g� <br />kIV 1p, <br />+ <br />15UBcarrnACTON <br />ucee G ' <br />aC-61 D-09 Other 1, l f�ueet=OL DrCTC <br />GEOWL'N*C.4l I TION: Ceoedeubs X Y Tere610_ Raeps 3se'Non_ CA <br />iNT04= USE V Dan06DQP 3M trrlgaOOMAgrkUU* Industrtal Water Oulay MOripr4fp 3d <br />Pubic We@m SysEem <br />Ma <br />rent eK tam OwNr <br />TYRE Or WOaN New WeA Rapmumard Wen WeA Aftrj6on#Aotfifleabon cow <br />monrtOrmgWed(s Sof waft SodBaing(s) e°reehgs .Glao66da7iral MCI' gr <br />Oit-ofSc ri Out-0fSenice W eA Renewal =WQ.1 ntlOef Rook <br />New D,m <br />Pump a Replaoernent ?i.mp Repair Rates i C.'L <br />jOrdfnq Meshed Mid Maury Ar kcaNy A,*& C.". Tpoi posh PpY. <br />proposed Wed DePM R Empation ir+ dWneter Open Softm GfsMl P6d4mvel Size in dameferl T <br />Condu= C&wV in dmmaw / Cor>dupu Ca sm Depth A V <br />Wei Casing Dwnew _ m Ttddmeasf06tpdASTM Schad Sbw pleft sb*dm Sled Ot)lsr <br />&*,A Seal Depth ft Neel Gmant (44 6 bays l0 901 Woef.) Sand ,calf mod? 9W water) <br />Bammmte (20'% sails) OIMr <br />- -Pfr2rRRee!Yelped Puneed Free Fm Other - __ FP. Wdant/A0edeeftrOMM— -- <br />PDTA metalled By Drfw . pump Ca*actor OeRsr <br />IF <br />PedesLl Dbnwfsibm Width _ ft $ Thi* Max 3Lore Pips <br />Puw V SuDrrRorsiele Turbine doer HP P=so U t S)l+l - A Wiley L" ft <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WOW V LL BE � M ACCORDANCE WITH SAN <br />IOAQUIN COUNTY ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS. 1 ALSO CIIRIW 1iRT MY INMOM LICam IS <br />CURRENT AND ACTIVE wrrH THE GALFORNiIA CONTRACTORS STATE U09dSE BOARD AND THAT 1 Ail N COMPLIANCE WRH ALL <br />WORKERS COMPENSATION LAW - <br />MINIMUM OU ADVANCE NOTICE REQUIRED FO INSPECTIONS - FLEA= CALL (209) 9 -7697 <br />SIGNED I' TME 1 " tyl a 4 DATE G <br />pN, <br />NSw p,Q0�11 GW��� <br />etw\RD5PA �Di60A�on Arrxptetl By <br />N�\J\A Groutlnspec6on By <br />Pump inspecnm By <br />Sal BOnnc InsDeanOn By <br />:;OMMFrrTS <br />TMENT U=�Y <br />....Dew <br />Dace <br />Date <br />B2b py <br />urIAL HEA) a;u <br />ZSER0CF <br />Area_`'- �^P+eYOeIDf►� <br />SAL YVeli Permit <br />WJMIet Roesivw <br />Canabaeimav" Dewth tt <br />WELL ~ Pe"T <br />��0 +2 <br />