Laserfiche WebLink
`{'-WELL DESTRUCTION PERMIT <br /> PUBIIC' - 'IRSYSIFM t]Ya ON, <br /> SAN JOAQVIN COVMY ENVIYONMrl1TAL HEALiu DCPARTMPM 304 E WeBER Ae.3m FL-STQ 'oN CA 95202-(209)4633130 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR MSPECM)N9 EXPIRES EAR FROM DATE ISSUED <br /> JOe ApDAEA6 271��0��pW��� ELH ST• crrvfdr "tzk FCA- 4524'0 <br /> CS.STRE, C/TT.a4XA+ Sr, APN PAYCCLSIZE_LANY URE APrLCATIGNM <br /> DWNER Gll`( OF LD AI PHONE 209-3.33 -(�900�Cx}.2b9D <br /> l)wxsR ADooess 22l VA• PI W4. ST. rnv/STArernr IAD 1 CA• �lr'-z 4-l <br /> CbNTYAcroR V• /W• D`R`/It-,u,,ss <br /> CUNTRACfOY AeoeySt IJ �-A � Ol ATAIE/dP <br /> XC4l7WELLDR..G Lecsm Nuaime 7,09 �, Rtv1RAn9NDA7Fe W _ <br /> M..ATNIN CbNce.cr.B MOVE <br /> MMRAMN CONrYACfOR ADWE38 CnYRTATE/AP <br /> C-57We110rilli.9 Lic.Number 7;�(3 C Fxpirmim Dam <br /> O Bumav ofAlcohal,Tobacco aM Firearms-Use.or High Explvaiver Ljrone Number Expiradm Dm <br /> O CHP Hacerdom Mamrid Tnv.p.Mmion for Explosive License Number Expirmion Dam <br /> O Sao JoWk Couary ShcriRComncr Explaiva Application and Permit Liters Number Expiration Der, <br /> O Cdiforoie Orapstio.al Safety Roam-Blastm Lirc.Nmnber E.1werica Dam <br /> REM MEORUnaEoueaoM 0 Dry E3 Replacement Well O Cav 1. 0. Pitwou leactivc 0 Tat Hole <br /> { Dmemed/Siupecmd WNt Wamr Cbvmmiunga) <br /> Adjattm propertywirhrooromioulare(Addran) <br /> KYown Shc/Water eooumiRaommadjxm pmPmy <br /> ESIDTar V& CommoCnON DE RS O 0P.Bomm 0 G.1peck 0 UDcaed O OIMr <br /> WeULogeopymsched )KYa 0 No GroatSnl O No O Ya_ftbelovvgmundaurface(bp) Hole DiYmeM mbes <br /> Well CoadumrCari.g 0 Ya 0 No DepthafCoodocror Caring ftbge DlamesrefCendumrCasing ircba <br /> WNI Cuing Diameter ivcbee Tool Deptb ft DePMta Water ft Depthof Cadog ftbge <br /> DE9TmICrmN SamvrcnnOM ,,// / //)� <br /> SMI.m MahNal Ra � <br /> n _RbgamR6ge FNe Mae.iNftmn��Rhgnm _Rbga <br /> Wdl mirmrobe g3llPy�3Eby^^e otMefaDewivemMadr. from ftbpw ftbge <br /> O MBs Knife Number ofmaevery ftard/or <br /> 0 ELplase O Ocmvativgcocl 0 withpmj«til..ry ft ❑ wimam Projeet3e <br /> O Dasetiogardandb.o.w. O withprojecrilaeveryft O reithvmp.pord. <br /> 0 age <br /> Seas,MmerW �( Nm Cmemr9Jlbbag(5-6galwreJ O Saad Cement aackms/7ENwasr 0 Boacceae PNIm <br /> O BenmvBe(24 Ud.) 0 Mecofazmm Spee%..lids % Nanm 0 Speaov File 0 Specs Submitmd <br /> PSEment Method PuvpM O Fra FNI 0 Wier <br /> Sal CompledoY A ComplmwithMmhroom Cap ftbge 0 Complete to Existing Surface Pad <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED MIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS.AND RULES AND REGULATION& I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS SPATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKRRS COMPENSATION LAW& / <br /> /tUM d R UV E NOTICE REQUIREDR IN£p PE✓CTIONS <br /> NMr1 ACPOYa So.NATBRE TITLE /ZW DATE OS <br /> 30 <br /> i <br /> n PAfR 7y,MENT USE ONLY / ,.y�� <br /> ApplimwD Accepsd BY ` ✓t/ Date. t6 �""--' Area <br /> . DnWttiov luepetiovBy Date ��� �1QO@� Employe lDS <br /> CO NTS <br /> - k LLL 6' t r. <br /> �E to rye c; parr--tea =-::-fl 4 14, 1 .1 oo s <br /> PE SC I Radved C Amom[ Perm1U <br /> Coda loco a Cn RemiNed Data Servka Re aM d Invoke p Wall IDS <br /> 2 zcdr Sp 4 z T't0j 13µ741 <br /> mr.umma ,1 w.o o.a.aeeramo- <br /> rmnms <br />