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• WELL DESTRUCTION PERMIT <br /> PUBLIC WATER SYSTEM ❑Yea ❑No <br /> SAN JoAam Couwy Ew w sssorrAL HE&TN DVT I M Ead Hannon Avueu-ETopRoM CA 96206-4=-ROY)406-5420 <br /> NON-REFUNDAKE PERMIT CALL 2D9 953-7697 FOR INsPECTioNs EXPIRES 1 YEAR FROM DATE ISSUED <br /> JosAwwas 54 Center Street C] fap Stockton <br /> Lwow sntacr E Church Street Am v�0 P.Sea Z-(L.Awo UM ArrticATaw a _ <br /> owmm PG&E P++oft <br /> owweltAwmes 8180 Folsom Blvd CTryMTATwzr Sacramento <br /> CowrwAcrnw Woodward DrMinA PNOK 707 374 4300 i <br /> COWRACmp AD0ft0&550 River Road CfrY/$TATLrz.Rio Vista <br /> CST WILL DPrlOOY L.Jr Ow rlrn.rn 710079 no wAnow DATE 7/31/2019 <br /> POWORATIOw C OWTAACTOw Ptiow <br /> ftwmATm CowTRAcTwt Aowlsas CrtY/STATR/Zr <br /> ❑ C67 Wei DftV Licww Nunbw EVinsibon Dass_ <br /> Burwsu d MooMw Tobww wW R wrrr-Users of Ho Explow.s Licuae Nunbw —.__--- ---- EViniaion Dote <br /> CFP Flnxardous MmWW T.aspoiwirx for EViosives LiCerra Nuntor ExptMon Due ----_ <br /> San Joaquin Comfy Sfw W-C;orortw Explosives Applawli n and Pump License Wnbw Borallen DM _ <br /> Qdlornia Oaxtpelbnol Baily HemMt-Bier Llouue Nurbw E oaibn DMs <br /> O Dry O RspYloe 0 WIM O Cimd In O PR Wig -- ❑ klscYve l7 T Hoie <br /> Dwcud/Su spocied Wer W~C=*wM wd(a)NjA -- <br /> Adiecant ProP«LY w1Ru mrft tMbrt(A*v* WA <br /> Known sou;wow owtorrA w,a at s*io«i prop"NIA -_ <br /> ❑ open Boom ❑ Gravel Pack O LJnceaad O Othw I Inko m <br /> W V Leg oopy aaached ❑ Yes ❑ No Orad 11" ❑ No ❑ Yr It, ', grand surboa PW Hole Dbwetw—.- Yfrhee <br /> Wei Canbotw Cw"❑ Yea ❑ No Depth at Conductor Cw*V R bps DMw~of Coro ckw Cadry inches <br /> was C+eMq olwnelwInctuea Tor Depth35 R Depth b WMwR DapM of Coe" _R bps <br /> semina Yaww *Cm 35 R bps to 0 R bps Filter Usk"_ *om_ R bqs to A bps <br /> Wei cwkV b be pSEREMEd by 0011 Of ft - *mw R bps bo _ R Dqs 3 r <br /> ❑ We Knife , Nunbw of ais rdwy R and I or <br /> ❑ Ejwloelves❑ n oord ❑ VM Isc I o wy It D aiMtokt pralecYle <br /> ❑ DMansYTp and aro boosiam ❑ with prclocbW avwy R ❑ wMuout prn}atM <br /> ❑ 00w <br /> Sealing MaterialNeat C4 mwTt AW ID b ep/5d pal Sud Comm* sack mbr/7 psi waier Banbnhe PeMeb <br /> nw tonke Pox -. % Nems 9paa on FM Specs SutxTWiW <br /> Macao"" 00,odPtnrVad Fuse Fd -- o1 w <br /> , <br /> Seal Cow*ktk Cap 3 to 5 R bps Conplab to Existing surface Pad <br /> i HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE W ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS,AND RULES AND REOl1LATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT ANO ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS, <br /> MINIMUM 43 HOUR ADVANCE NO�TIC/E' REQUIRED FOR INSPECTIONS <br /> CowrRACTOMSMATURE ' o-+ �,a-°!L"L-c� T.4 DATi / l <br /> s -14* t <br /> tO <br /> �Th F�MFiyTUNry <br /> STM NT <br /> AAPENT USE 0Y <br /> AppicaAccepted By <br /> lion DaM 71tf ATM <br /> DealructW",*.n trctbo By Date- - E-p IDI <br /> COMMENTSPE Amount <br /> pwnw <br /> Codas RTlo Cash Dale s R I Invoice I W.4 <br /> �um <br /> jqj;31-1�1011WIF00 2AS,2 <br /> FJ10.3.aa wEI.L DESTRUCTION PERMfT <br /> reriw/ <br /> 0V1a Y <br />