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HENNINGS BROTHERS Fax;209-545-1729 Apr 30 2012 10:10am P001/001 <br /> VVtLL/t'UMFa FatKMI I <br /> SAN JOAOEAN COUNTY ENNRoNMENTAL HEALT-DEPARTMENT 600 EAST M1AIN STREET-STOtKTON CA 95202-(20E)461-3420 <br /> NON-REFUNDABLE <br /> IPPHERMIT �(�]� CALL 209 953-7697 FOR i45PEC ION5 EXPIRES 1 YEAR FRom DATE ISSUED <br /> '�JOe AOOREei 7�C� �`...1 �f /� QTr/Lo ` azy V�y "$yr <br /> CRGAs S1R!!T� " `w k o k�APN J..13 -1)2-n 9I PARCEL SZE�, LANo Use A—ueAnoN 0 a <br /> Uo Wf-- L: 9x5 -$9A-2u72 w <br /> CYMER NAME 1f PHONE LSC' <br /> OwnER ADDREBa V ~9 Ir QS CITV/STATVZ? �VCrr'LarG.CA 14551 <br /> CONTRAC'OR <br /> CONTRACTOR ADOREet G Crn+STATERJP 1■` �' ,• IDr' <br /> SutcoM ACTdt PHONE <br /> suecowTRActoR ADOPAss CrTVISTATF/Zl. C <br /> LICENSE ,S? iC-61 0-09 Olnar NUMBER IlExp- ATIoN DATE <br /> GEOGRAPHICAL INFORMATION: CODrdln i X Y Township_ Range_ Section_ <br /> IMTC40ED USE OomesticJPnvate 9111crigalonfAwpircglAufal C Induse,al -,Water Quality Monllonnp ;;Sd1 SerTpLng/Cha7owrieatbn <br /> _ IPurilic Water Swstern a <br /> s: r yr .� ors sM �. vToa I <br /> TYPE OF W01% lf.419W Wen Replacement Well Well Pllefttlo'VMadIRraUon ONer_ 1 <br /> e ar ooh <br /> .N.ondonnp Wells) >t Of"116 :.,Sal Bonnp(s) � Geoterbmcal Of dporrP <br /> Cut-Ol-Service Wen F Out-01-Sernoe WeR Raneuol CMOs-Connection Repair <br /> New Pum :;I'Lla R Cement L Pump Ra e'r 7 Rol-Wcx Cevng <br /> WILL CONST ucnoN <br /> Dnlling t1MLhed ud Rotary Ar Rotary C Auger -Cable Tool t PMan Pont _ Other I <br /> I <br /> Proposed Wall spin �}1 Encaweon�._y_In alsmeler D Open Bottom XGtavel PaCJVGravel Size induaRlelef <br /> CoaduaW Caelnq In dtarretr / Conductor Casing 0601r r <br /> Well Ceelnp Demeter in Th nQSa/Gsuge/ASTM Sched 1 I-e.% D Steal testis C STa mesa SWSI 7 Omer <br /> Grout Seal DepEn_ r _R C Neat Cement(94 ID DepJ540 gal water Said Cemetn sack,";.;7 29:W;m `. <br /> Oton to(20%aorta Other <br /> Grout PlaCArtWnt etnod _Pumpe II Floe Fab Oster RaTaratnl/Acoekrelw(nerve) <br /> t)ESTAL Install d B DAller C i <br /> P f Y P ConIr6QOr 00)er <br /> Concrete Pedestal 0 Ileloner WAth n Lengtr R Tn-ek in ChristyBos Steve Prpe <br /> Subrn m6ls:"Turoine ::Other HP Pump Set R Stanalrg Vvatar.erel ft <br /> 1 HEREBY CERTIFY TWAT I RAVE PREPARED THIS APPLICATION AND THAT THE WORN WILL BE DONE IN ACCORDANCE W1716 SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS. AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT MY REQUIRED LICENSE 19 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS 6TATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> 141114;MUNI 2d HOUR ADVANCE NC CE REQUIRED R INSPECTIONS L <br /> SICRx`1 ED r TT �S.��cFvss9a0a E '3 0 <br /> I <br /> r 3M <br /> I Ile, <br /> RECir <br /> Its I <br /> EIVED <br /> APR <br /> a 2012 <br /> i SAN JOAQUINENTA <br /> I <br /> cN�pNP�T1JlENT <br /> F71 HEAL <br /> I <br /> A TNENT USE N).Y <br /> Apphranon AScgPWa By Daly y Av Employee we, C <br /> Growl Inspegpn 8 Cele7- SPECIAL Well Permit <br /> Rump lhbpecf n By Data WAIVER Received <br /> Sou Borng Ins lC a Data Conatructea weR Depth 1t <br /> COMMENTS <br /> PE 1 eeNved h N Amount Date PormlV invoice I Well we <br /> Info B Intalm1tted S*N1Ce Request 4 <br /> Pic, tj <br /> E"D 046 WELLMLIMP PERMIT <br /> "I" <br />