Laserfiche WebLink
" ELL DESTRUCTION PERMIT <br /> PU ATERSYSIEM ❑Ya�;XNo <br /> SAN AOAQUINCOUNI'Y ENVIKONMLN AL HEALTH DEPMrlu N ]W E WErER AYE 3-FL-$OCKTe1N CA"202 -(209)4AbNI0 <br /> NON-REFUNDABLE <br /> �PERfMIT / /1 CALL(209)951-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JORADURMS J V 1 S/M�h�Q_ NA /tai l /'UP_ CITYIVP t <br /> CR099 STREPr 19: /Vt a l N. 5;k 'ZLr f - ISO 2- ' <br /> APN PARCEL SIwl2�('j3 LAMD U9[APPLICATNINM o <br /> OW w f� (n] /^� .e (I;rwe4- PIpH[Zf9a�rQ <br /> OMTIERADDRLSeVN�,w17 h/� 1Id YY*/l�� jal4e— Cff1wATVLI RI <br /> CO TRACTOR 6j a ce.///off l/l l <br /> COH CTQR AOoaL9s 1 I•'f f' k/'d�/J Crrr/sTATIf/Ar //(O�IJ T� <br /> CW C-57 Wf DRILLING LICENSE NUMAERf/(fp FP-C E%rIMTKiN DATE <br /> PCRPOMTtON CONTNACN PMOHE <br /> PeRPORATIMC 111ALTORAOMe99 CMISTATEMF <br /> ❑ C-57 Weil Drilling License Numba Enpimtim Dale <br /> ❑ Buleu of Akolml•Tobacco and Fimims-Uspa of High EAploaives Uceme Number Eapintion Date <br /> ❑ CHP Havrdmu Menlid THDTpHutim fa Eaploawes Uanse Number F.apiratim Due <br /> ❑ San Joaquin County ShcdMCofona Explosives Application nd Pam4 Ucense Number _ Fapi-ope mile <br /> ❑ Califoma Omlpationd Safety Waith-Blanes Umme,NUmbm Eapindea Due <br /> ReA9QNwRDEsrRurnOn ❑ Dry ❑ RWlacemmt Well ❑ Cavd In ❑ Nt Wdl ❑ loaaive Cl TIM Hole <br /> Daard I Sm coaxi Well Waar Ceneamimnt(r) <br /> Adlamat peoperty wiill malaminaan(Addn'fe) <br /> Kmwn Soil/Wares ewtaminame at adjacent property <br /> EKITTING WELL CONniki ION DETAIIS ❑ 0.Baran ❑ GDvd Pick ❑ Uxa:d ❑ Mer r)' <br /> Well Logmpystuchd ❑ Ya0Na Ci-mitSealSero O Ya ftbebwg.od.rfi.(bgt) Noa Diaaicke inches I <br /> WNICondMtw Cady ❑ Yes ❑ No Depth of Mndue,u CAdq_ft bSDlamueror Coadmar CaYng itches <br /> Wei Cuing Diamaer imba Taal Dipaj;��ft Depths Water 24f,- 0 Depth of Casing ft lip <br /> DE3TRUCEION SPE0FICATION e <br /> Sellas Msudal frzm fl by IO R Eger Pillar Muedd flan ft by b ft by TT�.. <br /> Well oadngbh ont by ose of lke fMlawha llMkeds: frog_11 bgs a ft bp l� <br /> ❑ mill.KdR Number ofcun every ftaM/a fh. <br /> ❑ Eiplodves ❑ Dnomtingmrd ❑ withpmdmtiles.a ft ❑ without polccti k }. <br /> ❑ aner <br /> ❑ Uctonatingcodandbooden ❑ wnhpmjmilaeve ft ❑ wilhoatpoleaile Rl <br /> (` <br /> Beall,Maarlal ❑ Neal Cerma(WDAog/5figo/aerl ❑ SaMCement mcintr/7pl outer BeMwla Pegela <br /> Cl StolooRe(20Xaolids) ❑ Manufacvm SpeeMmlids % Name ❑ Specs Oe File ❑ Speoa Submined 'L <br /> Placemenl Metbod❑ Pumped FrceFall ❑ Olha !! "1' <br /> Seal Completion ❑ Compkoc with Meakrma Cap _ft by CompMe b EAldag Surlma PW t a S f n vC <br /> m <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT 771E WORK WILL BE DONE IN ACCORDANCE WITH <br /> JOAQUIN COUNTY ORDINANCES STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTURS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> INIMUUM14 H�ODUR ADV E NOTICE REQUIRED FOR INSPECTIONS y <br /> CONER ..SIGTIATURIE If. TfTLE t1"A1N DATEY'3-O$ <br /> P . ilei Ave, <br /> F L ff] I-'AY <br /> D I d I RECFLo <br /> j Ep <br /> sv 3 ct/08 <br /> .T, FN'y 90U/N <br /> 4. "Ea0„Oe Af�?u <br /> DEPARTMENT USE UN Y II <br /> Appliu4an Aacptd BY Mie .3 _Z Ate C' <br /> misuucdon Inapecrivn BY mile Employee Im <br /> COMMENTS <br /> /72o sycq._ <br /> PE Ic Rmdv. Aaouet mee PerMd Inroicef We"am <br /> COdea Info ! Remktd SeMnR meta <br /> EKD OOIM wdln —.-ren, <br /> .o. <br />