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WELL/PUMP PERMIT <br /> SAN J4AQt^.N COUNry Enyatgvnlev2u,(IL[>.ra DEPARtmtKt #14408 600 E.Mm.sn.a-STOCxKWN CA 9T_02-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECT IONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> v. <br /> JosAoauss 14629 47il:dwood Road CrtYfLr Stockton 95215 <br /> CJ[sss uE jack Tone ,APN 203-030-0^ <br /> - PAACESbl �."L LAND Uss ArnacAnoNa <br /> Ow"ERNA1m Marilyn Stanley PHONE 17O-4KK1 <br /> OWNLRAUDRESS 1910, Black Slate Court CmlSrarsfZs Cold River, CA 95670 <br /> CoN't mk Delta Pump PaoBT 209-466-9625 <br /> �CotrtxAcraa Apongss 646 S. California Street CvzvfSrnTVLu, Stockton CA 95203 <br /> svuco cnIR PRONE <br /> SL'9GDNTGCiOn ADUa m CMISTA'f VL(P <br /> uc, a 13C-57 )MC-61 0D49 ❑Othw Nunmca 724778 Etn[RAnoNDArE 08/12. <br /> GEOGRA➢HICAL lt?pRNAnaK: Coordinate X Y Towoa010_ Raoeo`_ Bubo. <br /> f[LVw -rp Uv.?Lll ppaxw)uPmrwe ❑tmgauon/Agriculraa: ❑tn:mei-.t. a V.'aw Quway Monitorlug M$.d ienpiivglLL�tenr m <br /> 13 Puwie Water s9yS= <br /> tf4iaeeet tbn O«w: m Yem eme -.•-�---( .-�7�—�.�- <br /> TYPEOFWORK 0N.wa O Rephsremont Well O WdI AIWufoM.MdiCwmion OOdwr <br /> ❑ManYoriag Welt(s)--------9ofwem 05ud Ronal O) nwbv QGCnmebnkal Yef1ipi�e <br /> OOw-OfSmw Well 0 Ow-of smze well Reoe+ual 0 Cross-Conaoadw Repau <br /> ONew M!nTEq1.ewa ❑LI 'v <br /> Wa':... .N.ttmICnO� <br /> 1MWoy Method OMnd Roury ❑Air Roury ❑Auger QC ldt Tool ❑Push Poim C3 Other <br /> Propoxd W'c0 GapM $ FYpypian kdismetw ❑Open Bottum O Gnvd Puk 10..1 Siw in dfin n� <br /> OCoadueur Cssing iodita urc1 CooductorCaingikpd, ft <br /> WO Cestag Dian w TAickncavOaugUASTM SehW ❑Stat ❑Plntk OSmmk sucl 0q I <br /> Grout Sesl Deptk fl ❑Net Coo d t94 lA hayI i.10 gal wan/ 0Saad Ccmcm sxk mts l 1 gw wamr <br /> OBccmaim(20%solptr) O.Menn(ectwer Spec owlid._% N. t ) 0Spea on File 0Spws Sabmined <br /> Ne <br /> Grout Ptaameat Mxhad �P1emjlCd ❑Free Fwl ❑Or OR mNuot lA 1 <br /> EimiuTBL insulted By ODrRv 0Pump Cnaasmor p Otber I `. <br /> ❑C.,.UPedeml Dlmeasbm1Width fl Length ftTwck 0Chri ,8 031 PIP <br /> xx NXSubnserstbk. ❑Tmbw. 00rher fiP Pump Sd ft sm.di, Wwu Lev l /+ O <br /> 1 HEREBY CERTIFY THAT t HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE 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 STATE I10EN'SE BOARD AND THAT I AM IN COMPLIANCE WMI ALL <br /> • W'ORKERS COMPENSATION LAWS. <br /> UNS 23}TOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> StcNhn T11LE CEO DATE 07/06/12 <br /> FITT <br /> Mimi <br /> f <br /> t 1 S ,t 'J 1N <br /> T <br /> 1 <br /> BE PA RIME NT VISE PNLY <br /> App6^uakaAM Wd8"J�t tote_i`l J� 'l 1(% Am q c 1 Employ—e" Ci <br /> Grout lmp"uw By pate ❑ 9PECULweaperrait <br /> Hemp taspedm _ pwc 9 ZL ❑ WAIVER Received <br /> Conetrudt<d WHI OePtl it <br /> cOMMEurskc'/Z %S�k-f2 =lll. L-fP=iil t,`?L�,>'- -�cn7c 7>•J f i.�?l '3 ^ �Y� e5 C� - <br /> • PE SC RcetNrd C$eddU' Amount Dere Permly Involrrp W'dl IDN <br /> Codes i Info B ..Curb Remitted Servltt Re anti, <br />