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I WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBOC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> JOI E.WEBER AVE.TURD FLOOR 11OCK ON CA 95202 (2UP)MB-3410 <br /> A y� --/ANON-REFUN ABLEPERMT EXMMS 1I It FROM DATE ISSUED <br /> JOB ADDRESS,T�T .1 O y on w w.w i�J MN .2090 <br /> 7%'p Z <br /> CIIYlIB -�'•{ PARCELSrm__QSSDTAl'/Iii_ <br /> OWNER NAME�Y�f� DRC9S <br /> Cr1Y?R' <br /> PHONE <br /> COMRAL-MR ✓fW 10IGL'IS ACDRESSP.D <br /> 3nx S/ <br /> crnr�I R10 J9s Tii• 9yS7/ one 9/L 7774/00 cn uceNseA 72s+ib DATE_ <br /> GPXIGRAPRICALENFORMAMON: COORDINATES X_- YTOWNSHIP_ AMjG E_SECITON <br /> TYPE OP WELL: O NEW NBIL O REPIACEMEM 3S^TbN 4D S <br /> WELL ( Mowrop. IGWEILIS;413 R <br /> INSTALLATION: OWEILSYSIeMRE,," OCROSSCONNECr REPAIR O VAPOR MBACRON WELLM <br /> TYPE OF PUMP: ❑ NEW OREPABR HP. DEPTH PUMPSET Fr, FIRSTWATERIRVBL <br /> Cl OUTORSPRVICE WELL OGEOTECHNICALs OSOI.BORING ODESTRVCDON: <br /> i <br /> � 122TENDED[RBF DRE OP W= CONRTRUCTTON SPEfwI aTION <br /> O INDUSTRIAL ❑OPPN;OTIOM WBL&CCAVATION DIA ?S CONDUCTOR CASIGD' ' 'L <br /> ❑DOMESTIC PRIVATE SSCRkL <br /> PACX/SIZE O.C40 WEILCASpfGTVPPE� WEILCASiNO DN .2 r• <br /> O MBLAYMUNICIAL ❑DRIVEN GROUPSEALDEPM <br /> SPBCBnCATWN <br /> OBIRIOATIOWAG MTMROROUT BRAND NAME —•t�ndaAl�— <br /> OKmoNDORE4G x U -- <br /> GROUTSP.AI.PUMpRD: GYPS ONO <br /> OCHRISTY BOX CSTOVB^^PI`PE/ CONCREM P®ESI'ALB DRBlER; ❑yES ONO <br /> APPROXMATE WELL DEpTN o{.] T'lIa9C rT Q cps U.nC_xAG]J+ <br /> PROPOSED CONSTRUCIIONMRBLNO MEIHOI, MUD ROTARY_ABR ROTARY A AUGER_CABI2_07T{PR_- <br /> I HEIIEBY CERTIY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL HE DONE INACCORDANCE WITHSAN <br /> JOAQUIN COUNTY ORDIANCFR.STATE LAWS.AND ANTLER AND REGULATIONS I WORK RTIPY THAT MYC-CTLICENSE 6CUR SAN <br /> AND ACTIVE WITH THE CAL"RNIA CONTRACTORS STATE LICENSE BOARDAND ALSONLAws. THAT IAMIl COMPLIANCE LICITH ENSE <br /> IS CURRENT <br /> I <br /> MINIMU OUR ADVANCE OTICE REQUIRED FOR INSPECTIONS <br /> SIGNED <br /> RITE SCy✓ie.< �HsorrS% DAIn��Jii� • <br /> 11.1101 YIAf HO1DRq <br /> 109-0]0-{ <br /> 33 34 <br /> tR DRE <br /> xo9-Do-x <br /> aARR11 taRRm 3y�-. �v" <br /> ROAo <br /> ao9-wo-9 Iva a.• P - <br /> �t <br /> mmlaxR m xo9-ieo-o9 '-{. - <br /> B' <br /> 299-1ea_1 xo9-lso-x <br /> SAND <br /> n <br /> ulxeAr m� <br /> x <br /> ie9-1w-.>q <br /> USE ONLY <br /> AMlinOm Aasprd By <br /> G1wn l9xpmtlm By _ J p- d y R/•5•ol <br /> Doolcnm W <br /> COMMENTS: �/xA< sAT LaN}7ToAJ <br /> -or <br /> PE SCAMOUNTCRP.0 <br /> CODES QIVBp DATE PHRM VICE REQUP$T• B'NVOK�• WEILm1 <br /> INPO RPMR'IPD CASI,CASN BY <br /> sIS)L &31G4 a o sz <br />