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V L: :: `_ "<WEi,L I PUMP PERMIT <br /> SANJOAQLTN CUtlMY�NVIRONMEVIAL HcALIIt DlpAet7MRNT 1 3D9 E WE6ERAV'C 3e CA 9Mn-(ZD9)r68,74I0 <br /> NON-IRmNIIABLEPER rr CALL. 209 95347697 FORInFECr1ONs E"IMIYEAR FROMDATCIssueD <br /> J41BADDRPSs /• r �� t CeI YIZIP I++ C n <br /> CRossSTpIZT ;~✓�J�r` AM --- 1r :� !j PwRCft.SrLEi' ;9 LANotrs UvLl4rtrtnN�i}t r��-•• -n <br /> ON7cEA NAs]e Ivy /pl�� �r/� ,Hyp��xE `a•i7'"/��A.+�']L 1 <br /> GWMAADDRFSS ✓ F ./- �Ctl1',$TATP1ZIl� • 4 �/ <br /> CANIRACTOR .r u , - 3 <br /> . CoNrRAUORADO><E6St-� 0TTSrAT✓Ell1 L-.C...-L.( <br /> SDaCONTRACM2 PdoNE <br /> •SURCONIVACTORADoi<CSs i 1STATrJLP • _-• <br /> r <br /> LIC EM ('-$7 b C-lit 0 D-09 0 011ttr +' PtV1tOrJl /�'f G.][PIILtTION DATL <br /> GEOGRAPHICAL INYOIORATWNt Cnordlastes X Y ya,` Tarrnrbip Ranze SeetloD_ <br /> INrztta[o Use O ie!!!ativaZ._•. J3 lrri$lktioafAgricuputtiti___alndutviai...... {lualiry iilmi[oriDg..._ ❑SWl 5ampliagrCheractairatirNt ' <br /> 0 Lilc Wlcr S r 1, f. . <br /> lrElRerem(mm�. ■rer wa r� d rma�r one um r <br /> TVPI OF-WO M-Nc'w—Wcll M Rcplecemera Well 0 Well Altcmdoo/ModiBmtV, O Outer <br /> 13MadmensWeD(2) 9ofazlls 13wlBorlaa(s) , k°r6°daj . alacaechaimlN. <br /> ea[lrarep <br /> 0 Oue Df•Service well - Q Out-Of4avise Well Rrnewal Lf Cwsa-Comt dan Rcpsir <br /> 0 Kew Pv O PuM R Isecmeat Q Amp Rt it <br /> WIML CONMUMON� � <br /> Drilvaghldhad t�11.1ud Rotuy i Cl Ab Rotary O Auger r r El Cahtc Ted ."0 Pok POW 0 Other <br /> PropawdWdl Depth�(7! It .. Excavation_ 11 iadismeax" ,C)OpenBom= i94rw_IPacklGrovJSize •indametu <br /> O1_anductorcuins " Indismeter.l '0mduetorCming.Depdi tt <br /> wcM Cesing Diemeoer-fl--in ThicknesstawgcIAST.M Sehed , CI Steel D 5tainbraa Sled D Otltu <br /> GroaiSed Depth a 4 ft_** UNmtCCMEDtfFl,bbag/S-10golwwterJ 0.S9MC..r JI L1k_ r.ckmh,TgelWater <br /> OBentottita{209Lsolids) OlfanufrrnuerSpQ'/.Wlids Y. Vwrtc ' I3Sp=acaFk, 0SPwasuwfw <br /> CmulPlacemenlMethW OFreePkD aCdter 0RdssdastlAeodewor(manw) <br /> Prnts�bl, ItutawBy ❑Orilter LFPaT-rpCautrectat O Other <br /> 0 0moreta Pedestal Dlmeaalosr,Wldtf �-� R Length 2 ' RThick In 17 cirwy Baa Q stove PI <br /> eta v nb .ibla C!Turbine Q Oder HF ; ___ Pomp Set R SIand1nR Wahl Levcl ft <br /> I MREIIY CZ3MVY THAT I"A,�-E PREPARED TNiS APPLICATION AND-HAT*fMF WORK WILL BE DONE IM ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORMANCCiS,STATE LAWS,AND RULES AND REGUI ATIONS. i ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIYB WITH THE CALIFORNIA COMRACTORS7 STATE LICENSE BOARD AND THAT I AM IN COMPLt1ANCE W,TII ALL <br /> WORICERSCOMPENSATIONLAW'S. <br /> MINI)IUM 24 HOUR ADVANCE NOTICE ROU IRED FOR INSPECTIONS <br /> SIGNED •f,•-..� r.. ,• T.2=---- TmtE_ t i, , - _ _ DATe <br /> ; <br /> i ' <br /> i <br /> i <br /> f <br /> I <br /> i <br /> E • <br /> 1 <br /> 1 <br /> if 1 i <br /> t rr44 <br /> a _1 <br /> • / / �D,yBPARTItlENT USE ONLY - <br /> AppliutitrnAcecprodBy -i�It=1 i�h'!.i!—If• m/u_e—Mm M11 G r f Ara EmploymlD# ��? <br /> Gtaot Inspection By Dsu_ p SPECIAL Well Permit - <br /> Pump]nspectinnBy Date I © WAIVERReceived <br /> Coastrwdcd WtU DvMh 1 <br /> (X*AMENIs TAr W 1 AIM/ A!r' 441 0111'611r <br /> re SC Reedved AmountDs[e i ParmlV Inroleatl Ws111Dr, <br /> Coda <br /> fare B Cuk eNllu.d Scrvke uatN <br /> ai 'D? klb a 5 z 4 71.7 <br /> V6,77, ZZ-1 1: <br /> I <br /> EM43.M.e« I wit rustrrtttatR <br /> tntneas <br />