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HENNINGS BROTHERS Fax;209-515-1729 Apr 30 2012 10.10am P0011001 <br /> 0tl.Lirurn11' rtKMI <br /> SAN.IOAOUN COUNTY ENIAROWENTAL HEALTH DEPARTMENT 600 EAs-MAIN STREET.STOexTaNCA 95207 1704)A68J420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7n97 FOR iNSFE_'1045 EXPIRES 1 YEAR FROM DATE ISSUED <br /> 730o flc�l70, Ra►. A <br /> 11 pnfDP ` GIC / 1 Soy ^$r <br /> ICRGaA STtc[rl. QT 1l1L r}IL�1lAPN/ti3 <br /> -02-C-41 PARCEL SIELANG U3t AoPUCA lON 9 T <br /> OWNER NAPE 0W `t PNOI.E-1/../ �a—z q3z^ <br /> Q <br /> IowNER QDOREfla V 1 �(ZS TY <br /> �. CI ,B TA TEJZIP LTV 1p <br /> .1rrYL.fG r CA J/4551 <br /> CONTRACTOR PNdN P I�8 <br /> CONTRACTOR ADCREe6 C. CI-1STATEJZAP I {E)d <br /> Buecor+Tn AC OR PHONE <br /> RUFC 1NT'kA[ ADORA8s Cmf$TATUZIv /J <br /> LICENSE (-j7 [fit D-O9 OU'ar NuKRER 2Q�A <br /> ` EJI VIRATION DATE <br /> GEOGRAPHICAL INFORIAATON. Coordm E.X Y Township_ _ <br /> Range Spc Uon <br /> INrt o o usir g91OnfA(ICCvIWIeI [Industnal -.'.Vater Ouallry Monitoring J Soil JenpknglCharaRiriTa;?Gn <br /> _Puellc Water STnteet <br /> Irsrto^an tro^. • v r,.E .�. o<a ate. c.. w•o�r it <br /> I <br /> TYPE OF WONT .W Wa'I Replecemenl V✓elt ONO' I <br /> ♦o'eon'7E /of bw-v <br /> t:ondonrg'rYe11(s) <br /> III Of walla I.,Sod 8onng�si I Geotechnical <br /> Cut-OFSe_Wel i- OW-OI-$ennce lNer RCOpwel C Croea-Cermectlon Repee <br /> !�a.Purr �PU R rnt � Pum R6 a-r _.Fa�sc Wt7 Cp6n <br /> WELL CCONeTRUCTO, ce n <br /> Dntllnq Method tud Rotary 4,Rotary C Auger -^_.ale 7-1 , Pugn.Po it _ Owe, <br /> !Propo�ad Wall : eptr, l�d n Expawoon _In olamele- D Cpe^IjOTIOr^ UL G'ewl POCk;Greve7 Size ;n dlimFl6t <br /> Conductor(_6"g Ir memetrr r (' ncu-Wr Casing Deplr c` h <br /> Well eaeing D,ameler$m 7Th1nesa/Lsug&A_STM Scned � D Slwl51a,niess Stesi D OlrerGroutSaal D pinNeat Cement IgA ro oegrS'0 gel:v$ter) - Sold Comarrl aac m 0 gal waver <br /> 120%sOtherC;mvl Placsmen hod _Fumpefat _07ter Rviarcenl1Acoele(Wor(name) <br /> I PEOEeTAL installYQ By..Y❑Aller mP Cdnirpgor Diner --- - _ - <br /> Concnye Fadastal Olm nelon6 WOth h 1plgln R Trl.Ck Christy Box Store P,pe <br /> Pure SutmeTblp=Tvtolne Olrer HP Pump Set R Star Dint W6Wr eel 1 j <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL RE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE 19 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS, STATE LICENSE SOAAD AND THAT I AN IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> RIIN4MUNI 24 HOUR ADVANCE INC QCE REQUIRED FOR INSPECTIONS <br /> SIGNED TI �SV JC rYa DATE Lq-3 0All I <br /> I <br /> go <br /> i <br /> I <br /> I <br /> RCFIVFD <br /> _ 1 APR �a 2012 <br /> I �pA(�l iN LpUN <br /> PL <br /> NTM DEPS ONMENT'SEN I <br /> I <br /> EAL- <br /> I H <br /> A�jT H E N T U S f N L Y S_X <br /> APFh;alrort ACODDtea By ---� it�Yr�pale 0 � A'ea Employee IOy !L <br /> Gro n Inepeaion By DeuL SPECIAL Well Permit <br /> PUMP In°Ped.cn E)y Dais WAIVER RACeived <br /> Soto 0, <br /> oIBot ng Inspectcn 8 Dot* ConeVu`la ell Dtpth f! <br /> CONVENTS. E/>� {c�� 2�5 >✓.Zt` /�'-ice -^,�__--��, <br /> PE SC Rewnred hoc N,,,: Amount Parm10 <br /> C odea In la B RamltTad Cate Servlca R ueit 4 Invoice a WeII IDt► <br /> I <br /> t��.J:,6 ..E__,s UMP G:Rw!• <br /> M.v(F <br />