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. qtioq 'Ory Wd�z : � [ 61H �oz ;�����, �,� ��rl� . <br /> IMELUP' MP PERMIT <br /> SAN JOAown CouNFf ErvamuIBSrALHE.ALTH DEDAiwawT 7869 EAsrHper-TUN AvEJUE-STocKTort CA 93105-(209)468342❑ <br /> MON-REFUNDABLE PEFAavT CALL 209 953-7697 rDR IruspEcMONS EXPIRES 9 YEAR FRONT DATE ISSUED <br /> 112b4 E e eman Iane Lodi , CA 95240 <br /> ;Jos Ao oto <br /> CRDSSSTREL-r Tretheway APV O O PaR3. USE APpISUa7tON j <br /> Brittalia Ventures PHaN= <br /> ROBox 170 Linden, CA 952-- 6 <br /> Ql:"ADn-ESS C(71'r�A7ElZlP <br /> �covrRAcraR Purviance Drillers , Inc pum, 2()9-887-35-5z, <br /> IcorrraAc aR AtIDRE� <br /> PO Bax 64 Crrv,3 rA>Efz�L r o d e o, C- 9 52 3 5 <br /> tSuBrovzaAcroR PHQ.�.� i <br /> !S:rBr.DViRJrCrUR ADOR-SS CrrftSTATEIZ.IP <br /> LICENSE cs; al t�J cD o 011,er uuuaEa 37 r 9 23 <br /> LICENSELICENSE 1](P6iATtC1JDAs 7/31/19 <br /> DD�Ls-r k(92LSA':P2l.v=0 General WerallCogatm flattens(439-1)-tDinrnlrochlorapropane(4392)=Risenic(4393) <br /> (fNTsmFDUSE C Dusne3WPrimrate IrriaatiardAgdcvlWral C Industrial G WaterO tyMtmdaring D ScilSamp[inglCharaderi�Gm <br /> J C PubGa Alyder System <br /> trdr3erecl Gum Glsrrv_ .t'aersysimrfwn U1,1 O Na=�F'La-ttmuDv ��Q <br /> iVPEOE Wo>ax ❑Nev+Y+lell C Reptacerrtent Well 6 Yu eQ PJteratlonfAdada"ieatien Olh�' <br /> nWaitorhowal(s) Ta11vmAs GU <br /> SaBaling(s) TornGdrr: CGeoteclinlnl '�Dm <br /> G Out-af-Servimvvelf C Cut-0`.Seivice Weil Renewral :1 Cmss-Cmmecllmt A,eualr �� <br /> 0 New Pump Jf(PumPFtePFacement Pump Repair 7 RaiseWall Casing <br /> wF�l Ccnrs�Rucnori <br /> �DrilLngtftWud O tAudRoMy C AirRalay 71 Auger 7 Cable Tan! C Push Point ;-1 Other >JAN AQUIJy <br /> iPropa;ed Weif Depth It E�,vaaarr Fn dreier --open eottam a canal Pa�craue]sEm in d- IRONM NTAL 7Y <br /> riCwduCmFCasng jndrm,2uT r CondudnrCasingDeplh 4 DEPARTMENT <br /> Well Casing DFarneter_in TnirlaessfGane1ASTM SSn?d Sleet D Pla!5iic 17!Slablrs Sleet D Other <br /> Grout Seal Depth ? -Neat Cement(94lb Dacrtlo gat crafvo D- Sznd Cement sad rml7 gal Wats <br /> I-BenIunRr(M1Gso5ds) .301h <br /> GrouiPlacement-Aelhod u Pumped 0 Free Fall D Other =Retadrnitttln-.r�aator(rtame)T <br /> FPMMALl- Installed By 0 Diffler 7 Prunp 0mirador ❑ Mher <br /> I e Concur E Pedal CI]imensions YTdlh r Length ft Thick in -1Christy Bax C Smvo Plpe <br /> PU.tiv Svbrnervhle❑Turbine J Other HP�_ Pump Set R SrnrBng Water Level It <br /> I HERc-8Y CERTIFY THAT I HAVE PREPARED THS APPUCATION AND THAT THE VTDRK V1iLL 6E DONE IN ACCOaMNCE VJrFH SASU <br /> JOAOUIN COUN-TY OMNANCES, STAT—m MWS,AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQ(KRED LICETQSE IS <br /> cuRRENr AND ACTIVE I rrd THE CALIFORNIA CONTRACTORS STATE LICE SE HOARD AND THAT I .0M IN CO3MPLU1NCE WITH ALL <br /> WORKERS COMPENSATION LA <br /> i JINI YI 24 H A 1 GE NOTICE REQUIRED FOR INSP=DNS-PLEASE CALL 9 7�g7 <br /> slcv�� �� Tl orporate Secretar&,, / � l <br /> II IA, I I <br /> I IX I II I til I <br /> TIE I I II I al I I iI I ! Ii I <br /> i I � I II fl I ! I I1 <br /> II k I 1 Il � ! ! I li illi <br /> III ! illflll I I � 1 ! I fl II <br /> I € 1111 II l IIIAi ! I A I I 1 <br /> I I ! i I I I <br /> ( 1 € I I I VI I f l I I I I I l i <br /> I I I li it 1 1 <br /> l i I I f G II Il I ill• <br /> I ( I I II III I II I fIII <br /> I I ! I I— <br /> I 1 I I i I I I I I1111 } <br /> i I i I IiI <br /> i i l l <br /> I ! I iLfI I <br /> PA TC.5EN7 U E O LY <br /> Aopiid&an ArsePled Sy Dale Area Emplcyc. tog <br /> Grout laspedtan By Date D PECIAL Well Permit <br /> Pune ImperBan BY`11, �� ,���f D. �)?ter�� .0 Watxfm Received <br /> SM Swing Inspection By Date Coristrursed Well Depth P. <br /> COMMEMM <br /> PE SC Receivad CheCIGw Amount Dane Permitl Invoice I WellIDK <br /> ._ in(o..-- _ _- —Hmtiried _ _ eryice_RequestF _ <br /> IfL27101 '✓ ull� '�3 I <br /> I I <br /> Er.�:3~� e�rnc 4/ / � /� / �� t-rsr-r=•vt;�uvr <br /> O d SLS L8860Z l/ oul slalli.lQ aaueln.Ind e6V 06 61, OZ AeN <br />