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(M-1 <br /> 1%w WELL/PUMP PERMIT `'r BCE #12919 <br /> SANJOAO=COUNTY EIRINOWENTAL HFALTN DE" 1868 East Hazelton Avenue-Stroanost CA 962056232-(209)466-3421) <br /> NON-REFUNDABLE PERMIT CALL 208 953.7587 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED L� <br /> Joe ADDRESS 2440 DANIELS STREET Cm21P hfATQTECA a 95136 ^� <br /> CROSSSTREET NILO CANDINI DRIVE APN 241-530-01 PARCELSME LANOUSEAPWCATONi N/A <br /> OWNER NAME COSTCO WHOLESALE PHONE 425-313-8100 <br /> OWNER ADOREss P.O. BOX 35005 CmISTATE/DP SEATTLE, WA 98124-3405 LJ <br /> CONrMCTOR JONES COVEY GROUP, INC. PHONE 909-972-7581 A <br /> 9595 LUCAS RANCH ROAD #100 <br /> COMPACTOR ADDRESS 9595 <br /> RANCHO CUCAMONGA, CA 91730 <br /> 6U#CONrHACTOP <br /> LEAK DETECTION TECHNOLOGIES LLC <br /> PHONE $2D-2 U7-4878 <br /> SUSCONTMCTORAcomoss 1400 EAST PASEO PAVON cm/6rATF1Lp TUCSON. AZ 85716 <br /> til <br /> LICENSE 11667 II C61 II D49 IOlher. NUMBER 804431 FmmRmoNDATE 8/31/2013 ti <br /> to <br /> GEOORAPNICALINFCPMAn": COordlnatesX Y Township_ Range_ Section_ U] <br /> INTENOEOUSE J DomesgNPrlyBto DlrltgathmAgrGiturel Xlndusiel ]WaterQUaflyMoRod 7609 SsmpirVCheracedreisn <br /> 7 Public Water Stam <br /> IrdRmeatkem er. WIMIUMUMNOW- ----- <br /> Wape, <br /> TYPE OF WORK DN=Well DReplacement Weg FWellAllemtionNodiftcatlon XOthw ELD MONITORING H <br /> 7Monnoft Wens) #ofyens 0801180drg(s) Adooke' zGeotechnlcal sahodrm <br /> 7 Out-ORSerAw Wei L Oul-OfService Wen Renewal D Cross-Connecoon Repair <br /> 7 NOW PUM 7 Pum Replacement D Pum R alr D Raise Well Casing <br /> ono <br /> LsJ <br /> Omling M¢iho 17 M Air Rotary C Auger D Cable Tool C Push Pant D Other <br /> Proposed Well Depth ft In aameter U Open Bott .vel PaddGrevel Size In aameler <br /> 1 Conductor Casing In diameter ft <br /> Well Casing Diameter_,In Thickness/Gauge/AS Plastic 0 Stainless Steel 0 Other <br /> Grout Seal Dept eat Cement(942 b; 109.IWaler) DSan Sack mb(f7 gal Water <br /> %sogds) J Other <br /> lit <br /> cement Method U Pumped u Free Fan U Oihw J RelardeM/Accelerator(name) W <br /> W <br /> OE Other (71 <br /> Ipump <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES.STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTNE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPEN6ATI0 LAWS. <br /> M MUM 24 HOUR ADVANCE NOTI Q 1 D FOR P T <br /> NT <br /> VED <br /> ?013 <br /> N coUNN <br /> ENTAL <br /> PARTMENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Dale Area EmployeelOR <br /> Grout inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER ROCOIVed <br /> Son Boling Inspection By Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received CheckM Amount Date pe w Invoke# Wen IDO <br /> Codes Into Cub Remitted SeMgRequest 0 <br /> Etp430S VAALaNNpP w <br /> Sec0e <br />