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CC INGS BROTH�FRS Fax;209-545-1729 Apr 30 2012 10:10am P001/001 <br /> wcLLrrU r ,,:,Fax; <br /> -- SAN JOAOMIV CCUNTY EWVI *MV INTAI HEALTN DEPARTNEhT 01)EAar(RAIN Swm.57ocwTON CA 95202-12Dp)40-3421) <br /> NOWREFtwDABLE PERrf1T CALL 203 953-7697 rOR MFECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> -73 -aG)Ao <br /> JaeAoomto .(` //V�/�� R-d. oTYJDD fi rc�cv <br /> (Caott vmttr f" MCW-Ar rA] arAPN Zl 91 PARCEL SIZE jkLA.N- tpAnucaTfoN s T <br /> OMrERNAME t �} L�CI� �...t Pllowt'reI.GJ <br /> (OWNER ADDnraa ` 1 Las os:TQb CfTY/61'ATf)2�. �v�r}Y`VDr� c� -17✓�/ I.. <br /> CMURACTOR .PNOW_ 54ST 118 <br /> I <br /> GewmaeTORADIlKW 35 IS -fcjcMAe- C-111S1AT6RJ► <br /> EuACo�mhcgCR PKONE II <br /> i. <br /> EUHCaNI},Acr;A AOOAIlK clTv(STArGlzlr s +� <br /> UtENaE S? r C-61 D-08 .Otht-- NUelarK EAOIKA7tONDATE -3. <br /> GEOGRAIlDtu MrraRtuneg: Cardin tea X Y Township_ Range SouloR_ <br /> 6;TrWIRn USF C Sirtipnvmle .��yoNAprcu7wrel t,Indusu mt ;L'Varar Ouallry Mvnllonnp i SO SLrtpLnplC,lla�rYriiallon <br /> PuenC Y Atter 5ya.tT <br /> 116rTrnrC Fern O.n�r M Yr e� onr. ea • were ur.ner I <br /> TwE OF WOKR ow Wel 'I Repkcemem Well C NtsD Ailara90NFfodrfiraimn =QIhCr I <br /> .;1{andaoir,p Well(s) X M vwlli 1.1 Sod Bann%(s) F°� 'Se Geotechticu: <br /> New pump rP d borfie. <br /> CnR-menwtc%*1 Out-Of$erw rs Wall Rsm" u Croea-Conntdlan Repair I <br /> w ,! Rcement L Pu Re ou D Raixi vvcA t;qs� <br /> WELL CONaTRUC964 I <br /> Onhlnp WM d ud Ratery/� Ar Rotary C Auger -Cede Toy! I'Puen Pots! 011ie, i <br /> pmpaeed Well im-15 ft E>caWEon �In dl9rlhelri 7 Open Bosom Grawl PaWGeevei She in p;amslor i <br /> CandLQL•f Ceoyhp \ In d,Arxmr / C0ne'VI"CetlndDepth rt <br /> Wet Caelap Diameter kFumpc <br /> Thi nosalGauge+ASTM Schell I I�� m Sleal IeMfe [Sla;ntcss Sud D Omar <br /> Gnaut$eel D pm it C Neal Comml fQ4lb DSV-'O gas*&I*,) C Send Compnl sack M74'7 gas wwor <br /> me 41000 Otrxr <br /> Grant Placgmerst Chid I I Fret FIR L OVWRaTMeasnt IAe6aleralor(name) <br /> PEoEIITAL Instzllfd B DAller Z <br /> Yr'� p l.ontre(loi Oh'her <br /> Conanele Pedestal Dlrn fletona:WAlh A Ler+gth R Tnrci in �,;ChrlsTy Boa "946ve Pipe <br /> SutmcmiUy=Tumins 7 Other "P Pune SM R Scaneinp Yvhtar:.evet R <br /> I <br /> 1 HEREBY CERTIFY TWAT I NAVE PREPARED THIS APPLICATION ANO THAT THE WORK WILL BE DONE IN ACCORDANCE M714 SAN <br /> JOAQLIIN COUNTY OftDWANCEB,STATE LAWS; AND RULES AND REGULATIONS. i ALSO CERTIFY THAT MY RWIARED LICENSE IS I <br /> CURRENT AND ACTIVE IMTN T14C CAUFORNiA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPUANCE VATH ALL <br /> WORKERS COMPENSATION LAW5. <br /> 41KNIUM 2d HOUR ADVANCE NQCE REQUIRED FOR INSPECT IONS <br /> SIGNED TTDAY <br /> I <br /> i <br /> I <br /> I <br /> I <br /> I <br /> ! pp'YMly <br /> ��Y <br /> I R�CEIV�D <br /> I <br /> APR -3 r� 2012 <br /> ccw�rr <br /> iAN <br /> S NVIRONMEw��NS <br /> i r i HEA!�p�PAR <br /> TMEI, 3E NLY <br /> A <br /> ,ph;,afi0n ACCx1Dt8d eye Dat! y riff Employee LOA-i--�--�� (�J/jj4 <br /> Grout Impecimm gy v Cala / 7- SPECIAL Well Perrllit <br /> Pump IRsplclrcn 9Y Dale WAIVER Rocf7ived <br /> Sou Borrtp Ina edwn l?! e _ _ Dau Con*Vu WeII Depih A <br /> CONIVENTS � <br /> 1 <br /> Ps calve p "Amoualt CatePermlVCodas Inb Service R4oues d <br /> N <br /> bpo <br /> I i <br /> Iwo UJi WE_:.sM'D GFRNri <br /> yGuye <br />