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WELL/PUMP PERMIT <br /> 3o1 E W[f[RAVI 3'e FL•$T DCKTON CA 953U1- (309J r66J�29 <br /> $AN JOAQUIN COUM Y Elrv'1RoNM0NTAL H"LTN D[TANTMLn2U9 953 7697 FOIi INSPEC-HON& EX))IRE$I YEAR FROM DATE ISSUED <br /> NON-REI'LINDAELIE P£RWTCALL CrryQv , r M <br /> 2) �y �'� rel ¢¢� <br /> JOf ADDALtJ 48—M <br /> ,1 �7— `�12 GCt't- ry US Y CA71oN d <br /> }37_U�`�I A�G(`f 1 L(�, �� r1 y �J� APJ� QZ� WO 01 PARCCL SILLg•12' ` , <br /> C1ois [ f6— ( I ( - NON[ J <br /> OWNtR NAM[ <br /> I lry �I <br /> OwK5ADPTWAS- I tJL PHaNt f ��� ZGU O'T6� <br /> J Rp <br /> 00') l3g n �4�1 o <br /> w S J i 'Lo o Cm/STATLI717�A K��1 ri n J-63 <br /> I � yyCONTRACTORADD1463--7L�a1�""SUBCONTRACTOR Wt,C C '!� O ✓S I <br /> 3 J IL W(i S7 C f I f d L r "_., ATT'Jfl'AT[JLD <br /> $U RCONTRAC70 R A o DRZ[S_ <br /> LICEN&t 57 . <br /> C)C-61 a D-09 0 oDKr NDAu,[R 6 6 2 o Eu1KAT10N DAT[ ( `� <br /> To.alblp Rar[c &erlilat <br /> r,[orkArA1CAL I?gFQK) AT;oN. Coordin.to X y J g li bpr�lorirarion <br /> 1rm No[D UAL O DemcslirJPriyavt ❑IrrlB.tionrAglloul urral D Industrial _O Wftrr Qutliry Manitaring <br /> ❑Public Wow SY.1L n+ <br /> Ir/iffvw.l lro.,O.vrr. .cw ern. naI <br /> [ wo ❑N.w Wcl) ❑Rcplaccrnr.(Wcll 0 WcII A11.(a1iw uo-0cnlon <br /> ❑O -rinyWdi(r) Y of yell. Oth" <br /> �SollDor n0)— 9 1d 0 Ga,cchniul <br /> Ou"OfScniu wsll ❑Olri-0fSrrYa walI Rcnctial O CroaLomcttionA.pLlr <br /> ror b.riop <br /> ❑Nc-Pum ❑ I.ccrncni ❑Pom R it <br /> �,�,roNtT!Um4N <br /> peMiL <br /> O Air Row/ D Aµ[nr ❑Coblc Tod O>'+>h P.im D Other <br /> Drop t.d w or D M W Rotary Aotsorn D Gnrvcl Parc I Gravel Sirs la di.rn w <br /> •5,� fl Eacfvtuion in ditvn.ur ❑OPcn <br /> Propwrd-WrL Depth�J' <br /> ,'1 O Conduaor.CruinB In diematar / CondLww Cuina Dcpth l fl <br /> Wil Cali.f Diamctor c(^�Y is Thi hncsi/GruydASTM$chcd ❑Swl ❑Plrtk D 31Ridm.Steel O Other <br /> j c� t yck wru 17 Rol water <br /> Grout S.W Dapth�-- fl '"NeH CG7tcM r94 IO 648'J•l0/OI warl 1'� t��L 4C4 0$- Filc D Spon SuQmiitod `' <br /> D Bon1crWe(3VII sclid/) ❑Mrnuran_f SW%.olid;^Y. Name <br /> Pu .d ❑Fra➢all D Aslw O Rctardanl/AccolalatOr(narnc <br /> Cra.tPlsctmrnt Mcth.e D m <br /> PLpCgf6L lartallyd IfT ❑Drillw ❑PvmD Cmtncwr ❑ L+gthR Thidc In O Cdrb Ba. O 5/wr PI c �l <br /> ❑Concrric Prdmlal DincvcRlune:Widd <br /> dw0, <br /> P S.1 n Standin8 Wncr L—d <br /> O Sub—rsiblc O Turbine ❑Oiho <br /> _HP <br /> 1 HLhEDY EP <br /> CERTIPY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BL DONE IN ACCORDANCE WITH SAN <br /> JOAQUItY COUNTY ORDINANCCS• STATE LAWS, AND RLILES AND REGULATIONS. 1 AL30 CERTIFY THAT MY REQUIRED LICENSE 15 <br /> CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCY WITH ALL <br /> CURRENT AND ACTIVE WITH THC <br /> WORKERS COMPEN6A710N L1W6. <br /> M1 .1 UM 2a HOUR ADYANCP.N=C2%QU1R L)FOR 1NS�1'EG tInNS <br /> TrML DATE <br /> slcN[D <br /> PAYMENT <br /> ECEIVED <br /> e JL 2 6 2005 <br /> N JOAQUIN GOOT" <br /> ENVIRONMENTAL <br /> TH DEPARTMENT <br /> DEPARTMENT SE ONLY S31v� I q <br /> D. 7 (OS Arcf Ertlplgoc IC1( ��/ <br /> Applicvtion Acccpwd By ❑ SPECIAL Wtll Permit - <br /> &wl Inspcnioa By Date .7� O <br /> Dal, 13 .WAIVER RccclYOa <br /> Puap Itupoction BrY _ <br /> ConalNticd Wd1 DcPth _ A <br /> COI 4ENTS <br /> AwcoRrt PawiU lavo(utt WdIIDa <br /> pT SC Rxrhrd Dau $crvicr R■ unt Y <br /> Ca1.1 In(e R Cub Rmkt.d 2>59 <br /> 1 <br /> D .C.3v•cJJ Z <br /> WpU WAEA FLUCT <br />