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D `L12-& <br /> WELL/PUMP PERMIT 1V413S-()Cq <br /> SAN JOABUN COUNTY EArmeommemmL HMTH DEPARTMENT I,WE"THADILTIXIANAWe-3TOL%TONCAWM5-12891 MB+1{20 <br /> NON-REFUNDABLE PERMIT C CALL(109)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FFROM DAM ISSUED <br /> Joe AoWl q31 y (YV --oa l CTR. S*CIt7lil '/SaZO& ^� <br /> CROW STREET /%�1/Y-/NJ� APN I ( �a Oj111 PARCEL SQE VQ1 UM0 USE AP�P/L�ICATION0 <br /> OYRRR NAME Y(/a�ljfrnr -/ PHDNE :J�'N R- I/1/V-/`l <br /> C"ts,..Tm. CA, I& N,, C-4 9Sd06 <br /> CONTRACTOR 'VLr ]© / f/� �,�{1 /'r, l yl ;/1� S-f3/ PXOAR, ZQ-9-3ll -3r�701 <br /> Cd cleft A00aEW �190/t ~n� / FlA\l DITYIBTATFRV Gc�E r'A tom! 9Sd�y <br /> SWCDNTRACTOR I" A PNBNE <br /> SU9COMIRACTgr ADOW" LITYM�y'ATyFJ�Z�IP/ <br /> LrcENRE VG57 C411 DOD OMer Mum". �plG /VNl E..IM.DAM 3 3/ / � <br /> GFOORAPME4 INFCRMAROM: COOrCinake% V TOwnMiP_ RapBe_ Section— <br /> INTENDEDUM DoirArWc Private IMINkmAglkultoal Ineustnal WakroontYMONtonng )Y$al SartpNyCharatledzelon <br /> PulNc Wakr sym. <br /> x6xeeeNkmmOxrHr. w aril^ °r <br /> Tm Or WORM New Well ReptrONnent Welf Well AiteratloNMOdiicalon Other <br /> MOrvtohrp W.Nsl If f.0. SOA Boringlsl .ereulrO. hG.aedraul � erwlanrw <br /> Out-OI-se wo Out-Ol-Servke Well Renewal Cmee-CO,e,RObl PAR" <br /> New purr, l Rel Puryq,Repair Rise Well CA <br /> WEUCONSTRucmn <br /> Drilling All KLA Frotery Air Rotary *Auger Cabie TOO! Push Pam OtNN <br /> Ptoposetl Well Depth ft Escavalron l in diameter Open Bogan Gawl Pa[k/Caavel She In demeln <br /> COeMuel�(CaNrp n+damMer I Co Nuga Camp Depth I <br /> WNI Chirp Diameter_m Thic luGauge1ASTM Schee Steel pkstic Stalks Steel Omer <br /> Grout Sul DaVm I <br /> Imw eaitlat oNema«t Csmee+m' 9lNr5k-fs0sgel hell GK }� Wci"nan Bakr <br /> _ugI CkBent.a. <br /> NI <br /> olO pknrrwrt Medved PanpaJ Free Fall Otl ReWCanl/ACcelOMW In <br /> )'E�.97EL Newl BY Driller Pump CorrvaUn otr r <br /> CI,,Wl pee.dl Dim torn Widh ft L rah I Thick n CmAtV Boz stove Pipe <br /> Suhrnda lk Trtu Other HP p DSel rt Starving Walertevel 9 ] <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DOME IN ACCORDANCE WITH SAN <br /> JOAOUN COUNTY OROINARKES. STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERSCO ENSATION LAW 5, <br /> OLID U UR NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95 -7697 <br /> $pMEp <br /> C.. TRLE Se...,.17✓ f}5.I' MTE Z .z S <br /> - <br /> N <br /> REC�lEF-r <br /> Ea v <br /> SAJVZ ZOJf <br /> Nf ENS R USN Co <br /> J,.._ ALTH DfO ARNTy <br /> �T <br /> � <br /> /�_{!_-, <br /> Application ACCepled BY Data ARa Employeela�'C!w l l C <br /> Growl Inspe L BY Date PECIAL Well Permit <br /> PumplrLTpeclon Dek WAIVER Received <br /> SoA BONA Data y Cro.tructed WAR Depen It <br /> COMMEN-.3 ¢ s <br /> PE SC RNK w" - Amount DabPemdV kvoke a Wee lDa <br /> Cod. Into S GM RemKke Seervics RoNulI <br /> 3,0� <br /> wEr.lnea.v.rwr <br /> Hp teM <br /> .mnz <br />