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WELLIPUMP PERMIT <br /> 50o Ens+Mux S'REET SrocaioM CA 85202 Roglvill 0 <br /> SAN joM,,COUNTY ENVIRONYENTAE HEALTH DEPeviNEM m <br /> F07�NAME <br /> NREFUNDABLE PERMIT CALL 2091953_7687 FORINSPECTIONS___ �.�•,EXPIRES 1 YEAR FROM DATE ISSUED <br /> ^ '�rMIARCEI SIZE V=-�_LnHD U9!APPIrCLT10MY_ F <br /> 2900 <br /> PHONEPNO�JRy�1.�.�04 ��-�T^`.—�i�—��-- CrTVTS+n:t;ZloMEsa <br /> SuaOoxroAcrmCIrIS+n*EILIP_I <br /> Er_,)�/ ISI SyYLOMnAOTOq AOOREae-� XPIRATOMOATE e/�/)jPRel <br /> - <br /> La:ENOE �I GST ♦C-6: D-420 - I <br /> Y TO'NNM11P_ Range_ 40clbn_ <br /> BEOORARaOALIMORYARON: COOTdarabsA __ ,_--_ <br /> InmOEYUYE IDOmE'sik/PrivYle llMOelbNPyTICOINrnI IrMRlnel �W01eI DIM."N+nmlOfinSal1 <br /> O 5OmDfin9lGneraE@nI21i01' <br /> L PUHIC WeA` sYPlem ,ro <br /> 11 EIM/an aam MPer —, 0, <br /> TVOO OF WORN ( New WFmem WeR R R'"Pe W II AI NM diYwODn •or pr„y' Geolecnmcal a OT raMg. ' <br /> r <br /> 10,011tong V*,"(s) a of wNls Soa Rodng(sl C,.s,r.onrleabn Penan <br /> r Out-01-Se Om.06$ervme Well Re't'Tel <br /> RarsC Well Casino <br /> L NawP vP m Re bcemenl r'Pu ReeOv .__ - - <br /> F <br /> C- o TON Pyr11 POW Olnei <br /> prNtlrp MaNOd ' MUO ftalery Air R0lerr Auger Cable ip0l -- <br /> Proposed Well DepU n 6mvagon_-_ <br /> mmamerer Open BPnOm GTevel PecklGevel 5lEP mASlrorer <br /> r Canductol CeYnq m dam8lel T Cmdu .I Cas.ng Deple__._R <br /> In Th1clonsslGauV,1ASTMScned steel plmbp st.miess Sleel Obe/ <br /> well C"1119 Diacoele+ +O AvaleO Sand Lemem saeA muO gM wYm <br /> Grout Seat DeDln R n Heal Camem(gup oay5� 9 <br /> I- 5enbnl1(20%a0gea) Olnel Rebrdanl r Amela/Ylor(namel <br /> STAN,PIE M Mad P ped F FII OIM1 <br /> �AL I.a,Yllad Br 1 Driller I Pump ComTTNdpr IT angan R rmcw n CMeH fiat n SIOve Pips <br /> C COTic TO PadsI Dlmanslons NRdlp --- <br /> ..: ... - HP,-, I OLlrrp SeI_ ._ ... EII Siending Welel 1-1 a <br /> O osui nM010Mn Tudxwev!R..__- <br /> I HER BY C THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WOAft SO CERTWILL IFY THAT DONE NMYCREQUIRED LICCORDANCE ENSE A15 <br /> -I <br /> HER <br /> OUNT' ORDINANCES. STATE LAWS. AND RULES AND REGULATIONS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATi' ANTS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED2�FOR INSPECTIONS S <br /> TITLEJ3 W '--�' DATE . <br /> $sWEO <br /> -r <br /> I <br /> . l L -4 <br /> MENT <br /> RIVED . <br /> EPARTNE7/i' <br /> DEPARTMENT USE ONL" <br /> Pren VS F.mgcYee tDa-fLi/_l- <br /> Cale <br /> AtPe <br /> amPladBY M' -'—' WAIVER WISH Pe <br /> Grad ln,mmmEb <br /> sn BY Otle �/ /.2, � WAIVER ROCOIVYd <br /> PunT lm IIm BY Ij•--Y COnsTNCIed WOR DPPIn R <br /> DaIO � <br /> SpE Bpnng <br /> COMMENT$ <br /> ----'- --�_ _ -Pe.1" InvOlcaO Wali IDT <br /> PE 5 Ramlvad l+acsa Rem ttW Data sorvke Ryuasl a <br /> Codas Into B bas _ <br /> c 00 L <br /> 371 53-- Go? _ —— <br />