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WELLIPUMP PERMIT <br /> joAelul.14 COUN-,y .868 East Hazelton Avenue-STOcKTON CA95205-6232-(209)468-3420 <br /> E TION' EXPIRES I YM!jtROA9 DA-1'E iSS.9.E.R� cf, <br /> JOS ADDRESS J <br /> CITYMP ............ <br /> ��Z.PARCEL SIZE"_?jLLAND USE APPLic? <br /> A <br /> CROSS STRE <br /> �f .......... <br /> P <br /> AVDDR-�-I�S e'e'41yy Al 6-1 n- <br /> PHONE zz <br /> CiTYISTNIE01— <br /> ::,3NTRACIVZ ADDRESS ZJ- Z�Q, IZZ�4�4:s---' <br /> ------------- <br /> Crty/sTATezip <br /> UtiiISER �L*—Crie"...... EX"RATION DATE.- <br /> 0-0iii Otho, <br /> -37 <br /> Township_ Range_ Section____,,. <br /> a F''Vele 1.lridos lvial <br /> RaPAcernen,'Alai! Nidi AlieraticNiv;odiiicaCa't <br /> Cr Odier <br /> of wells Sc i';Boring(sl <br /> OLj!-Of-Servtce Rere%'Wal Cj Crass-Connection Repair <br /> u:: -,.p .:.P,rmp kenlO:xment :'Pl;mo Repair ,:Raise Well Cas'nq ---- -- <br /> Ift-thod t4.iji Aomar�- Ajger 1"Cable Tool Push point Z Other <br /> -Z�a!Sma in dizmeter; <br /> Oper,80ttOM ravel PzeX" <br /> C,)r,.-U(,jor <br /> Welt Csk -,I Stainless Stem0 Outer z_in Sci,ez /&I. <br /> Grout Seal Dopm N=C,4;r tont(94!b ray 30 San'.Cement <br /> Sack mW7 get view I <br /> 01her <br /> pu:nped f.-, Retardant!Aweerator("am, <br /> pumpContracwr 'V Mae <br /> 11 in PiPa <br /> Concrete Redesta) ft _enginThick Box Steve <br /> Pump <br /> It Srznjii,,g Water Lsvel ft <br /> I IIERESY CERTIFY THAI' : 4AVE PR:CARED-,xIS APPLICATION AND THAT THE WORK MqL6 BE DONE IN ACCORDANCE WITH SAN <br /> COL*J-ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS, I ALSO MRTIFy THAT My REQUIRED UCENSE IS <br /> CUI%RENT ANS ACTIVE WITH THE CALIFORNIA C014TRACTORS STATE LICENSE BOARD AN THAT I AM IN COMPLIANCE WITH ALL <br /> UNORIAERS C0161PEN'SATJON LAWS. I <br /> UM 24 HOUR ADVANCE NOTICE REQPIRED FOR INSPECTIONS <br /> E <br /> TITL DAT <br /> )7 <br /> -o' <br /> 24n <br /> -71 <br /> f-, <br /> Litt- ................ <br /> .......... <br /> ---------- <br /> Wil <br /> 4 <br /> ,,;I,'PAR' 014$ Y <br /> AplsGraz-,,)A;�c��ptoo Sy EmPt-Y-ll)P'or <br /> An <br /> Gfom2 IrispE&I"A 1 ti SPECIAL Well Permit <br /> Pum- Date d WAivER Received <br /> Date Constricted Well Depth ft <br /> COMM XTP <br /> FE RoceivoG ChecAX -' —Amount-----Dale -` PmmEV 3nvaiee �—' Wag ID# <br /> Codes i Into By Czeb tted Romi service Request# <br /> .....I......... <br /> �-O --------- <br /> 7 <br /> ....... WELL IPLW PEFUT <br />