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WELLIPUMP PERMIT <br /> $Ali J DAQU II COUHRIF EMIR01i'aE MAL IIEA1.111 DEPT 166/Fast Ili teflon AVenUe•SIOCKTON CA 95205.6232•(20911614420 <br /> NON•REFUROALDLLEE'PERMIT CALL(209)953.7697 roll InsPECtlous FXPIRES 1_YEAR FROM rDATE ISSUED {Q <br /> JOOAODRESt (V 'tit-Q'� C,1YOP c✓ 1•(gc,(c ,)^ -IJ ZI� iT <br /> s SPLuYyeO <br /> CROSSSIREft Itx41,44 APN52?' : ELA•.n USE APFLICA11030 <br /> Os'rt:ERUAVE K4.o.W A.-,`1rCf rnoscyiS-�$3! A (Uv1/�C <br /> Q1'dtTRADDRl33 _!—L_I Wit.R,�,Sl L3rG� CITYIStAtULP,f l���I cA ' /C/� <br /> Co!tIRACroR ruoAc 7 <br /> ,0-3`L 'y100 <br /> Co:tTRActoRADDRE3355-t) I?-..".- Q. A. .0.(IoY 33<0 _ CITYIStAIULP R)o UJGA �C♦'S'7� <br /> sv.occoRTRACIOR �t^t ta,CJ-�cy l�-Rw�t-1 Pllouc <br /> SV1�OIRACrORAODRES3 2.1-35- ItLe,cA,r' 1 Ww�/_SJ'�T( �C.IIY `F <br /> ISTTAIIIMJ`SGwL. !L V(r+ rGA 5C'N <br /> Licv.m C.57 11061 IIOM IOOIe( F IAWOER�.kErPIRAnon DATC tf/' 3{"20(.7 <br /> OE00RAOXCALIrl/ORmlou: Cootdlnatos X_ IS'.1� Yf 2170S31'o.$7 Townshlp_Rang*_ SCUIOn_ <br /> �PII[ImFo UsE J 1anos6eP4v3l4 U IrNal" Iftrrvitlural r IndulVisl J Waler Ow;y Monlod02 8Sol Samp'vv9'Ch3racltrttatcn <br /> i Pol4c%ValcrSys1em <br /> rterntal tt.l0nnc Pl'i!u a a, r-wLolmillrec 1�1.� <br /> JYP[O/WORK JNev Wc7 U Rcpiacemcnt Wctl W01metaCaNd0drovon YOher� Sp: ,. a• IO t <br /> LfCr00dnSN@E(s) 90h'X11& SoJDorry{s) a.ltavl t 'eolcduaN �klty^a <br /> 3 Ou1.01-Somfea 11.43 L Oul-01-S1P&A V.'c3ltcnestal J Geos-Cdvtectien Repatr <br /> J Novi Pump II'unri Replacement :l Pon g Repa'r uRalse\1@[I Co9ng _-_— <br /> SVELL CaslRuenoa <br /> Drilling Molhod i Med Rolaly •Alf notify I Auger U Caho lod n Nish Pdnl Ai Other�t Sao{ hv5l� <br /> PaoposedViell Depth c;- II Excaysfon Ind•anu:er uOpen0o3om u(xavclP.x)JGtAvd51to Iredame:cr <br /> ,CeneuCterC3s;rg Indanelcr I ConladorCas'MgDepth A <br /> WallCAsing (Yameter_la Th!unossFCau3dAST1.ISched .15lecl I Plasec uSla'rless5!et1 UO:her <br /> OroutSe31 Depth ,R nl:eatCcmenl(911b0ay/S/Dpatua:0r) jSardCenstnt stc'murpatsva:er <br /> ]nc4l*mIo(20'/,SoSds) 1Co0,erUntki,�t Soli vJ'ltyfe.+ <br /> OroutPOcemenlMothod uPo-v Ed N(ceFa:1 aOher .IHolardanl/Atcekm:cf(nano) <br /> Imum Installed By a CrIler U PumpConlrador U Other <br /> -I Concrete Pedosla)Olmenstons:%%Wds n 1trglh R Tthk In n Christy BOX --I SIM PIP <br /> VP )SAnsetS;UeJ Twb'(1e 13lher IIP__ Pump Sot R staM'vlpLVa!ales•el A <br /> 1 HEREDY CERTIFY 711AT 1 HAVE PREPARED 71119 APPLICATION AND THAT TIIE WORK WALL DE DONS IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDWAIICES,STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY TIIAT FAY REQUIRED LICENSE IS <br /> CURRENT AILD ACTIVE WIIII THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS CO.'.1PENSA71011 LAWS. <br /> I <br /> FAIN�I61U6124� 11OUR ADVANCE NOTIPEREQUIRED FOR INSPECTIONS <br /> slostoy ) I- A L'NL i TILL[ k Aafit <br /> Q'�_T _- - -- - _ ---- -- - --- - <br /> -- --- --- -- - - - <br /> -�,T I__1; ;.j- I — <br /> DEPARTMENT USE ONLY <br /> App':cJWn AscrP!ed By 04!0_ Area Emp'oyoo 1111•— <br /> OroutJnspeu'on ny 03:0 SPECIAL W011 Ponnit <br /> Pump Inspection By Dale WAIVER R0C01V0d <br /> Sol BorleV InsFecCon By Dalo Constructed Well Deplh 11 <br /> COMISENIS <br /> PE Sc Itecolved Checker Amount Pontl1v <br /> Involco is L'leII10R <br /> Codes Info -Uy_ Cash ItenduDal*cd Scrvlc0 Request it <br /> uwnc-s v.nsss•rarctvn <br /> AOKI, <br />