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HENNINGS BROTHERS Fax;209-5d5-1729 Apr 30 2012 10;10am P001401 <br /> rrtLL1t"UM1J rtKMI I <br /> SAN.IOAOUIN COUNTY ENMIRONMENTAL HEALTH DEPARTMENT 600 EAB'MAIN STREET.STOCKTON CA 95902-1209)467-3&20 <br /> NOH-REFUNDABLE PERMIT CALL 209 953-7697 FOR i,V5PEC'IONS EXPIRES 1 YEAR FRON DATE ISSUED <br /> JoeADDRE:S �3co afro, r��yR-�►. .�/� �TYrao I- ra�cv °15 Soy $�Z' <br /> CAoaa STRtCT f.4 � fl(jQ�h r•�)LSfAPN Z1,a X 61 L i 1-' L PARCEL SIZE <br /> LAND Use AAUCATN)N R 2 <br /> IUMRNEA NAME ` 1LV - �1,I11 PNgrE9z5 -g9A-2u72 <br /> 10vmfR ADDREas ��J_9 i....DS OS ^T"Oa� F-�y• CITv/6i,%TVDP L% cr/YW ir-C,CA 9y551 <br /> 1tACTOR 1 <br /> CONT <br /> PNOMe 54S <br /> CoNlirACTOR ADDRESSC CrT1 STATUE► 1,►l AC- M yJIS <br /> Bua[ONTIIAC Ql PHONE I <br /> Suac OHTwncTOrr ADORAs6 CrTvrSTATU1ra <br /> LICENSE Vf,S^ Cfit 0-09 Other NW BER EJc►IRATION DATE I <br /> CrEOCAAMOCAL INFORMATION: Coondin s X Y Township_ Range Section_ <br /> fNYLrNOEDUSE OomesUdPnvate gaSon/AgrcdlWral L Indusfial _:Water OUallty Nontlodng J Sail Ssr.pEnplCharjDSn¢arkn I <br /> _P`uclrc Nla14r Sister <br /> Ir&MSK.tram v-ns• v yt n•t o�� em o� vov i; <br /> it <br /> TYPE OF WOR[ w Well Replacement Well r WBII AIIetadoMJoddiufian _ONar_ I <br /> ♦a•eon^w adbamP <br /> Vondonrp Wells) f of uveae 1.,So.l Bonnp(sJ - Geoterhnrul <br /> Ou!-OI•Servi—Well :' OuFOF-$ernes Well Rena,-al C Croea-Connedion Repur <br /> New Pu'rp PUa R cement L NMP Ra a'r -_�Raise Well Cewn <br /> WELL CONST UC T.ON j <br /> Dnlfing hAethoa ud Rosary At Rotary C Auge• -Cable Tcol i Pus"Pont _ Olrer 111 <br /> I <br /> Propos*d Well eptnIC50 ft knaveaon_ In dlameler C Open Bosom XGreval Pack/Gravd Sixem 11.1K <br /> C«lducto,Civylp In dumerer / Coniuctor Ceaing Daplr h <br /> Well Casing O.—ter m Thl nssUGiug*/ASTM Sched 1 40 7 Steal 1591, C Sta rile"Steal 7 over <br /> Grout Seat 0 ptr, _Neal Cement(04 14)Depr,10 gal wale,) 7 Said ComersJack TZa,7 gal water <br /> enta+ae(1019 Soho Ott" <br /> urtoItI PIac ~ ethod .,Fumpe I!Frv*Fall L other Relareanl/Acoelerator(name) <br /> !�PEDESTAL InstaRtd.B rte..:Drlder ,p ContreOrtx Olney <br /> Concret*P.destal p nslons-VKtlM A Length R Th.CK in Chrlery Box Store Pipe <br /> PUMO Submersible TurDlne Other NP Pulp SelR Stvrdlnp WaIK.B viol R l <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL 89 DONE IN ACCORDANCE WITH SAN <br /> JOAQUfN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT MY REQUIRED LICENSE 19 I <br /> CURRENT AND ACTIVE ,)NTH THE CALIFORNIA CONTRACTORS bTATE LICENSE BOARD AND THAT 1 AAI IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> M1IIN'MUPA 24 HOUR ADVANCE NC CE REQUIRED FOR INSPECTIONS <br /> SIGNED STVrG r�A 4CATF '3 <br /> r 1 <br /> i <br /> I <br /> i <br /> I I I AT <br /> PAYMIVED <br /> REC <br /> E <br /> APR 3 4 2412 <br /> ENViR N1µENTAL <br /> N TM <br /> DEF ENT <br /> I I I i <br /> ARITMENT USE NLY <br /> ApFhauon Accsotsd By- Z pale O 0.v Employee 101.. <br /> Growl lnJpegOn By Cato Z $PECUIL W!11 PlTrnit II <br /> Pump Insped.on By Oat* WAIVER Ra ceived <br /> Sof Born Ins cn B lab Corwvu ell Depth R <br /> COMVENTggj <br /> PE SC Recanred n*c N_ Amount PermW <br /> Codas InfoB ltr "amlRed Cate Service Request 6 i Invoice a w.a IDr <br /> 10 <br /> I <br /> I <br /> I 1 <br /> t'+O•1.X <br />