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y L) WELL/PUMP PERMIT u a <br /> SANJOAQUMr COtWrr ENVIRONMENTAL HEALTH DEPARTMENT 364 E wraEe Ave 31 FL.STOLkroN CA 95203 -(209)46S.3420 <br /> NOR-REPUNDARLE PERMIT CAUL 2y0�9 953-7697 FOR LKSrECTIONS EXPIRES 1 YEAR FROM DATE ISSZ1IRD <br /> ,no AnaRca _ y. ,/f flC�/S� et S Crrvn. /t GI� SZ Z. <br /> CRggE$TRggE j i� F� APN G:l� PwleeEE.Srxe-A <br /> OwraRNAat. r►� /w)�++AII S-Z.88-Q�_ <br /> OWMtRA�11Q[ig G Crl'YlS7'ATPfLa <br />` CONTVACIVR [� Mass <br /> COhti11ACTORARDtIRii 817q CRYISTA'VZIP i/Fi®r✓ (_.J3 ,,__ii <br /> SiU✓1COMMACTOR PI[picE 1l" <br /> - SU.COKTRAC-TOR ADDaEM CIITYISTATLMP <br /> IJCiIR -_37 DC-6j E D.OCOteNumn"37 730s ENRAYODA7. _v(/ <br /> / <br /> m <br /> ' CtaDt,RArlRGt41WlORMAT70ltr Ce.rdietq X Y Tew.ahlp Reese SecM.a <br /> IN 948 Use�omo Prlvae O Irtotiay <br /> Agricelwnl O tuduwial ❑Water Qtallry MeeieurinE Q So(!Shrnryiio <br /> D P:fie Waatr 5ysum P'ia°Oq <br /> ubiEtrlhnrh Gvs ow.�.r .� <br /> I w <br /> 'EYPi OP WYoaat "B%kW Well r]XWtaadnaat Well ❑W911 Altention/Moditihcuiaa 0 Tew"04a la ptbetr - <br /> ❑Maaimrirtg Wtll(a) renevw.ntr E3 Soil Raring([) a,.aewewup O GenteelhaitaT nuaaae Wewiaa <br /> ❑Well Drahthc[im Cl 00-OFService Well L]Oul of-Service Wel(Rurewal <br /> Pu ❑Pump R521WAMMI [I Repair E3 CrmrConneatot[R it <br /> WtasCOttsntucr <br /> DN{Yag Mob" R9tvy Q Air Rogtr;r t]Au r ❑Cable Taal 17 Pugh Pain[ <br /> �ygt ❑Other <br /> rMew ed wall Depth :Z JGa R arse adcn. J in diameter QOpen Beltom ieevel PaekJCn.vrA Sine in diameter <br /> ❑Cwwww Cemtg ie diwwwr I Canducuw CuioE Depth R <br /> Well Coreg Diah,wm �f. ThicIft-M�GsagdASTM Schell BO <br /> �'� .....ip QSOd 'Veu& O9"Iez.Steel ❑Otb., <br /> Graf 8021 Depth R (3 Neat Cement(94th 6W/J.10g&twfer) <br /> QRmtanite(20%solids) QMaoufiletwer3poc%Falids % Nar40 �SandCemoer__ �1t 3 +urfmir/Taalw.ter <br /> + Cr9at Ptaearrrpa Math.d Serum C.]Speen on Fib l7 Spxa Submitted <br /> Pod ❑Frsc l:et ❑Onc�r d Relardrutt/Aaeletatar(NaNte) <br /> { l raesrAx 1Y�111�@Y riller C3 PutppContreemr 1309wr <br /> PUMP <br /> Q Caaereta P+daatel Di.teatiaiar Widtk it Lot iY R Yhick In Q Ch <br /> ti711 Bog 4 Now PIP <br /> .. tbnte[aible 13Theiilne Q Other_ <br /> t►'kaE.Drarrtucst!Ott [3OW Pump Sd fl Standing Waw Levd p <br /> pen Rata.t O Onva}Peak D(Jac.aed in T9 <br /> ❑ 13 p(�. <br /> S <br /> Well D16MOW <br /> Ce�s tai Ikpth Dreh m Wa <br /> 11 pter (( 13 Casing to b.PcrfotaWl rmm R l9 >t <br /> eallag Mehti.l meae(Aa lbEvg/J-IOlprrlxrnwJ ❑SerdCtanepl �- <br /> ❑Baumite(20%solids) ❑M*M&c a %wlida iatat Nefr/7 gal water Q 8eatatriie Pelota <br /> Pfae.aatRt Rt.tMd 0 spOO --_% Name (1 Span m File ❑$pea Su6eniped <br /> Pumpad Q Ftae Fall p Other_ <br /> 0 Complete with Mutdtr9aer Cap <br /> fl blow <br /> Bade 13 Complala to ExudnS SmlYce Pad <br /> I TIMMY C1GR'17FY THAT I HAVE MWARED THIS APPLICATION AND THAT THE WORK WILL WE DOME IN ACCORDAWX WITH SAN <br /> JOAQUtN COUNTY ORDINANCIIS,STATE LAWS.AND RULES AND REMLATIONSG. 1 ALSO CERTIFY THAT!MY REQUIRED LICENSE 13 <br /> CURRIMT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICEMN BOARD AND THAT r <br /> WORKERS COMPENIiATION LAWS AM IN <br /> COMPLIANCE WTTH <br /> ALL <br /> mIIVI UM 34 HOUR ADVANCE!NOTICE REQUIREa FOR IAlSFECTIONS <br /> Slcttao �,� <br /> TtTls1 �lCh- a <br /> DATL <br /> AWiowon Accepted Sy DEPARTMINT USE O Y <br /> Gmtn Iatltatiaa Ry iJak A,,. @ /� <br /> Due mittoyrr liM <br /> imp t`° �SY _ <br /> � SPECIAL WeH Permit 10 <br /> l <br /> I]eava[int in.pnctlon gDOEsy Q WAIVER RueelYed <br /> Ct)7r1MHF7TS y Dare <br /> Caealrected Well Dryr� <br /> R <br /> Codes SC Ameaat <br /> Infe RemHNd Rurelv� Permw <br /> 0 B Oa4 <br /> a ■ Servin Re 0 lavokv r wer11D11 <br /> 0 6 <br /> FHU a3-02-000 ' - ' <br /> t' <br /> *� O O 344 5_5 STEM WATIER WELL PaMtT <br />