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966� ' N WdtiS :E 6106 'Ciurm <br /> ��'a - <br /> 1Prr= UPid1MP PERCU1H l <br /> SAn.loaaoe�CAlkItY EtmRortMENraLHi6Ar 11t D�AscnaBzr 1863 EAST H&ZaL7QN AMLlE-STDGK—r-A qM5-{2139}468-3420 <br /> 14ON-REFUNDABLE PERMIT CALL 2139 953 7692 FORItvsPEcnONS EXPIRES't YEAR FROM DAZE ISSUED <br /> a� <br /> .lea Aaarr2ss 5006 crrvfap T.i n d n A 42'16 <br /> Cc <br /> CR=SM,Wr FrontST APN PARCELS==— t AND115EAPPLICJL7IDN" Cc <br /> 6 <br /> PtroE209-887-313() R <br /> OwNSINnrtE Mu�c�i c� Rrant- - '-' <br /> OrajER Aans=ss 5 0 0 Fi- c a CtrdSrn a <br /> co.rracrca Furviance 'Drillers, Inc i Z09-387-3554 <br /> CwsraArTaa Aui3g i PO Box 64 CMlS-I„-�LLnden, CA 9523h <br /> SuacaN-.anaroR PFtot c. <br /> 1Slaaconrnucrmz AnnaEss CmrISTRTs2+r <br /> U.SE n C W a r� 3 D-� D Otru r Nu&mER 3 7 7 9 2 3 fYSIRATIorI DAT. 7/ 1/19 <br /> Dec.Es-icLnr>ElS��rs�Genesalnamoralfrou(om 8satrsia(4391)=D`mrarnochlomPmAane(4392)=Arsenic(4393) <br /> laremm Use t DumasWFrhrate G InfgarianlAgKmAWral G lntfu_stral G WaterQua1iyPdomTorin9 O SollS=P6ngfChara=1e-dz2Hun <br /> C Pubrmv ter System <br /> frdHfe=fr0MCnur ur0er5p&:nl=e Caen n'ane arPeoa:Nmnrsr <br /> 1 YPEOF WOA-K Cl:NwrVAO C Replz a t Well G Well Altera3acrR7odifiea8on D Olher <br /> MamlatinB WeIl(s) �aflYetts GSeIIHar:Agls) ^'d�D°T L-G1=oleclarical ''rte'=` <br /> a Quwf-service Weu c cut-crSenr;L--Wen RenEw zi 3 Cms4Cmmecum Repair <br /> r,Nea Pump 1b Pum tacament C-Pump RepaIr 3 RelseWan Caste <br /> SYett cah=ucrov <br /> I".IlInErMediod V-U-udRatacy G XrRatwy O Auger 7 CBbieTual :3 Push?cW D 01her <br /> Proposed Well Depth H E=avaUcn Fn dameler U Open acacm C Gravel ParylGrauel See in dzeweler <br /> D CanductarCesing in deter ! CcnducbrCaMng DEpIh :! <br /> Weft Cagiag Dimietei_in ThidateWGauge1ASTM Srhed =Sfeel 3 Plastic D Sfavdcss Sleet ]Q3 Er I <br /> GmutSeal Depth 3 .3 NeatCenent(34lbbapS40galrrale* 3 Smd Cement sackmfd 7galerata <br /> C Berl=iLeQ 7 %=ffdS) 0 Outer <br /> 1r--routP12cexnuntMe!hrdGF4zmped O kezRali 'DOther =RstardanFlRcca'eratrn-{name) <br /> PEo13TAL fresfaliedBy D Dr9ler ]PranpConkWGr 0 Other <br /> e Cancrme PedEsmr r-Dtmerlslons7W-dtD ft Length R Tbirlc in a Christ 5= 7 Stave Plpe <br /> P ,a f S.tbrnev3We3 iurt iW 3 OUter HPC_ Ponta Seo Tl Standing lNater( vet ft <br /> I HEREBY C.EK 1FY THAT 1 HAVE PREPARED THUS APPLICA-Ma AND THAT THE VMRK WILL BE MNE IR ACCORDANCE WrM SAM <br /> .IOAQLRN COUNTY OROM=CES,STATE LAtVS,AIS]RULES AND REGULAMMIS_ 1 ALSO CERTIFY THAT MY REQUIRED f10ERSE IS <br /> CURRENT AND ACTIVE WITH:HE CALIFORNIA COA.riRACMRS STATE LICENSE HOARD AND THAT I AN IN COMPIIANCE WITH ALL <br /> WORKERRS C01VENSW ION LAWS. <br /> iIR1fUf11B T 24 !3/RNCE NOTICE REQUIRED FOR INSPECT oms-PLEASE CALL 1209)953-76ST <br /> � Tt-rCorporate Secretar -7-iii-�� <br /> flli f I 111 I II1 ( I ! <br /> II I ILII I II 1 1 f <br /> 111 II 1I II I II 11 I <br /> 111 I I1 II f ! IIl1 <br /> I I I I I 1 4t' I I 1 1 1 1 I <br /> 11 1 I I ! 1111 <br /> 11 1111 11 I I I1I IV 14,n I <br /> Il Ifl 1 ! 1 I IIk11 If 11 ! 1 I I <br /> 1 I I 1 I 1 1 1 I I I <br /> 4 � I II II Ilk I I III <br /> I1 1 1 1 1 1 1 1 1 r,;i <br /> 11 1 I I I I I I I ; I I I I- <br /> I II Fu I I II I IIIII I f 11 <br /> 1111 I Illi I it Iii I � LIVED <br /> -- - <br /> I II L I I I I I I III II <br /> I k l ! I ► <br /> =.UW262M <br /> A &IEAlT 11 E NLY (�Date Area -/ Emplayaet[' If I COUNTY <br /> Gmutl=pecifanW Date .0 SPaCIALYWell Permit ENVIRONMENTAL <br /> PumpinspecRon r Date D UUAIv�2Received HEALTH DEPARTMENT <br /> So1T Smftig 1=e=tion By Date Constlucled Well Depth <br /> COMME{VtS <br /> PE Sc I Received Checker Amoun! (Joie 1 Permitl ( lmralceT I y y1/eI1[ <br /> Cosies--..Info.-_'• -- __ —c2 -- —Remitted _ f Service.Rsqu !: <br /> I ;177� twigI WO(Me P2 <br /> ! I <br /> ! ! I I - <br /> I ! <br /> ! <br /> rli_.Lrluu,'PEW=, <br /> E`rJ�^3 EOII:S <br /> Z-d tZgOL2960Z oul saalll.lQ eoue!Aind d L V00 61 66 1nf <br />