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INELUPLIMP PERMIT LL SArajoAawlCoturYEwmoarasvrALHsa=rtDs-A"aNT 186SEASTHAZIR-MNAVENUE-STaCtcTONCA9 05-(209)4683DZD NOAT-REFUNDABLE PERT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 4 YEAR FROM DATE ISSUED 1.103 ADD 6220 CrrYJZitl'i n d e n 9 5 2 3 6 n CROSS stRI•=r Walnut Dr APN 1�r '' Pwncrosw. t� 7 USEApnuCAnoNm PHarv916-761 -4482 cmiz Na=- E 4 oart--cAAat P.O. =Box 1 048ctt�Isnr�PLinden CA 9526 CONTRACIDR Purviance Drillers, Inc 209-887-3554 CaNrRAcmR ADoRE55 P O $o x 64 CnTJSTATFrZFL i n ci en, Ch 95236 ISUaCoNrRACTOR PHOr= SDHC0,1 mCmRAMMM CTTYISTATEMP L teEnSE n c s; u C,611](L ❑OTlter Nutttea 3 7 19 23 ExPmAmoN DAr 7/3i/19 Ont'=.. s-rmL4L-LLSAwn_w=U General ffmml[Caffhan Bacteria(4391)=OiDnamachtampnopane(4392)=Arenic(4393) IMOMEDUSE a OemasticlPrivale nigaGonlAgdeuiWral G Industrial G WalerQuaLlyMomloring ❑Soil SampEnglCharadetaa6an C PubliicWaterSystem lfdffd=lfMMCreer =ffrSyst=tva,e Cwdx4 t�ca ar Ptloa:Nmnhet T YPEOr-WaRK G Nm WeB C Reptaement Well G WeD Altera un(Mod-iliicallon a ODier E Mamtoling Wel<(s) #afvrPlLs G SDl Barings] ralmeTs L 6eoterlmi�l =ms s r,.LII1 eruice Well C OuI_O`.SenriceWeg Renaral ❑Crt>s-CGT1nw9an Repair NevrPump ri Pump Replacement cj Pomp Repair 7 RaiseWeDCasino t,VfiLLC0YJS7RUdTf0,J �nAlYiingMethod O Mud Rotary C AirRntary ❑Auger O Cahleiool 7 Push Point . Other Proposed Well Depth ft Excavation in diameter =Open Bottom C Gravel ParklGraue)Sae in d-2meter G CanductnrCasntg in diamelrr I CanduclorCesing Deplh R Well Casing Diarnater_in Tnidmes0G`aug&ASTM Sched • C Sleel O PlasiFc O Sta-frdess Sleel 7 Other Grout Seat Depth i, -3 Neat Cement(S4 lb bagr310 gut wated :!Sand Cement slrk rrizl7 gal'rata• O Sentmlite(20%sofids) DOM Grout Placementrillethod C Pumped ❑Free Fall 7 other =RawdantlACceleialar(rrame) PEnESTAL Installed 6y ❑Drgfer 0 Fump Conita= ❑ Other I ❑Concrete Pedestal CDlmensioasWidUz P Length RTttitic in '7 GfnisiyBaG 7 Stove Plpe Punto O Submersjbl urbine 7 01her HP P;;—Sq—=0 Il Standing Wales Ltd TI 1 HERESY CERTIFY THAT 1 VE PREPARED THIS APPLICATION AND THAT THE WORK WILL_BE❑ONE IN ACCORDANCE WITH SAN 1OAQU1N COUNTY aRDINANCES,STATE LAWS,AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT BOY REQUIRED LICENSE IS CURRENT AND ACTIVE VEM THE CALIFORNIA CONTRACTORS STATE LICENSE HOARD AND THAT 1 AM IN COrdPUANCE WITH ALL WO MPENSAMON LA M UM 24 CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7097 sle - TCorporate Secretar�AT I II . I I I I II I IIII I I I I ir I 111111 I I I I I til i 1 IIIiI I IIII I II f 1111 I ! II } I II it II i Ill Iillllll I I { 11 I -I IIII I 1111 111 I i 1 II I II { 11 II I1 till I I III 14h f I II OFTFI I I I I f I I if ! I III I lllliI 1 JI 1 111111 1 I1 III I ! LIF I I I I I Fi I I I I i 11 I 1 1 1 1 I I I I I I l i II it I illl l I IIII II II ill { I I I 111 t I I I I I I l i I I 6 2019 III i 111 II llll I I 11 I I 1 I I I UIN COUNTY i f i I I I I I I I I NMENTA(_ ❑EPARTMENT U E LY bEPARTMENr AppricdianAccepted By ❑ate A C' / Atea EmPllrfaelDR Gaut Inspection Hy Date O SPECIAL Well Permit PtminspercanayKaor- l ) • l.%7e f`y1 Date UUAIVERReceiUed Sail Baring Inspection By Date Consuucmd Well Depth R COMMENTS PE SC Received Cheot�l Amount Date { Permit! a Invoice# f WaD 1w Info.._ —B ;. Cah .---—I;emtlted _ I Semice.Re est: I I I t _ I I I tr-�n:::eT�Tr E7-:3+ zarr.S