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HENNINGS BROTHERS Fax:109-SAS-1729 Apr 30 2012 10.10an P001401 <br /> VMLLIVUfft' Vt=KMI l <br /> SAN.JOAOuN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EAS-MAIN STREET.STOCKTONCA 95207-1206){67-3420 <br /> NON-REFUNDABLE PERMIT CALL 1209 953-7i197 rOR NSFE�'I0V5 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOVADDRE66 -o, R.�, 'r rc,cvSoy <br /> � CITY(La <br /> Car••STIR'lT a� f n�>�r•}��jIAPN 2.1 '0 L in <br /> 1 L4 I PARCEL SIZE 3--%-IANO Use AWLICATION F <br /> �GvmERNAKE PHOwE92S -g9A-2.472 <br /> ,OWNER ADDRESS V J�� L-CLS �S\ ' �D CTY(BTAryZ,L:v cIrma ir'r-,cvt 9455 <br /> 1CONTRACTOR y-- PPMOMe545 I1<H5 <br /> CDNTRACTOR ADDRESS e G C�TYSTATULr 1 F odes <br /> 9vaco."Ac7cm PKONE <br /> B treCONTRAC CMI ADOREai CITY,STA TE/IIa <br /> LICENSE S'7 Col D-OS Cr},ar NWBER 29aAI� 5 -'31-12 <br /> EAPIRATON DATE <br /> c <br /> GEor uFKICAL 1.4 %4ATO4 COOrdin f X Y Townsa <br /> q_ Range Section_ <br /> Iw D o rs Oomestld�nvale t44rlga2ontAQrcuj&ur&i L Indusafal -,Water Ouallty NonitorIAQ Soil jEr*p4np!C,haragar;ya�lcn <br /> _PUIIIC Water System <br /> TYPE Of WORK ew L'Vi4 Repbcenenl VJalt WSU AltereflovNodfiuUcn = ONS' I <br /> StOnilonrp'Ne'llsi *Of wean S0.1 Bonn s •>'WT. . Geoted+mol ldoo^p• <br /> C <br /> C'!-Of-Se—Well Gut-Ol-Sero¢tvel ReneV,vl Z Croea-CcMedion Reprr <br /> Na..Pu� C Pu R cement Pum Rf a'r Fnse well Gvvn <br /> SWELL COhaT CTOv <br /> Dnwnq Method ud Rolary Ar RoWr/ L Auprr -Cable Tw1 , ol,ar P0 it _ OIGh <br /> a roposad Well eDtn 150 B E.cavea0n In dl!-fele! C Cpen Borw- XG-evel Pec"ravel Sire m-iimeler <br /> Conduoor Cea:n6 Ir aumeler ! C.mcu=r Zafln,Deptr 4 <br /> WaliCaanp D.ameler� TM nosal.ifuQWASTM Schad I I�Q C Steal tesl'c C Sta mess Steel C Over <br /> Grout Seal 0 D,.r, _Neat Cement(94!D DSw5-'0 pal wafer) - Sa,d Cemarn Sac«1.7 pal waxer <br /> ertcnne(20Ye 8000 OV er <br /> �Grvu1 Placfinenl ethod -Purnpe II =rea fall _Otner Relarc ant/ACOelela!or;name) <br /> PEOESTAL installed 6y...n DnOer r*,P t.OnHacTOr - Omer <br /> Inlcrefe Padasl�l Dan ft La^6tn R INC, Christy Bos -Stove Prpe <br /> IEIW :;Submeryrbla=Tur0lne ::Over HP Phmp SM d Stor.aInp WeWr_ev81 q <br /> I HEREBY CERTIFY TWAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCGROA14CE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS dTATE LICENSE BOARD AND THAT I AM IN COMPLIANCE lv17H ALL <br /> W3RKER3 COMPENSATION LAWS <br /> AIIN'MUMI 24 HOUR ADVANCE NCpC-E RECJ!RED FOR INSPECTIONS <br /> sroREO Tj�!J d�'}� 'Sv��rv•�eD:E �!-3 <br /> I ' <br /> 00 <br /> I <br /> i ide <br /> I <br /> i <br /> PA114YMENT <br /> RECEIVED <br /> APR 3 L 2012 <br /> SAN jC)AU-1 <br /> I I ENVIRONME TMEN1 <br /> li <br /> H - <br /> ?t-!D <br /> EP <br /> AR <br /> I EA! <br /> -117 <br /> ATIENT USE NLY <br /> APtII;�uon A[OaDWd By' Dal• O v Av Employee IDM `J /-C <br /> Grout Inspeq,on By DeW / Z SPECIAL Well Permit /(( <br /> Pump Insped.M By Dae WAIVER Received <br /> 301138or'll;Ins �cn 8 ;�- DeW CorwVu ell Oegh R <br /> COMVENTG <br /> SC Raurvod II N Amoum Cate PArmIV Nlveice a Well ON Info B Remtteed Service R uesl d <br /> —� <br /> E+D alfa wE__�waEEaur <br /> OrDbEa <br />