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WELL I PUMP PERMIT <br /> vSoAQyrS CoOnxY Er+vruati+tevrAi <br /> HEALTH DErAtxi ML- 304 E WEER Ave 3"6Y-SrnrscToN CA 95:02-(2U9)3!fL392i1 <br /> NjQN•REFt;VDABI.E PERMIT CALL.(309)9$3-7697 FOR INSPECTIONS EXPIRES 3 YEAR FROM DATE ISSUED <br /> till <br /> 1 dols waaterws $ <br /> 1 � <br /> � jCaosaSrAesr._ AP;� a.d 2-1r,;a-LLS P;.Acfc.Sa�.�_ .17K;«otrs-eAreucArw�� _ I <br /> 1 11 c h <br /> PHONE <br /> 1 Ow%TA t <br /> I <br /> PHONE <br /> �o.I��AAt>nR>� /�P.a'S'� ��r�"'�i � _.�_ crr,Isr,.re;�ar..���-''/ ' �.� .• <br /> Cnwrw.�zoA { �� CMISTATArLip <br /> CpNT�ucrOR ADDRI;Sfi t� t 7'! /��l"• �"'� <br /> PHONE <br /> SVw'0NTxAcl'Osl <br /> 51;act>h-rwcroR Aa»» CmY15TATP/7xP <br /> . .. - NL'i�BEA 'ExYt'kATI-o'qDATE 41ae � <br /> iLICE'iE •S7' ClClil ,GD09 GOher` <br /> 3 Raage Y Towm4lp__ Seetiou�_ <br /> f GPPftICAL IYFLY}t#IATIAi: Caordlnatts K ❑Soil Sa:rpl erg Chmc cirai+oc <br /> Iutmr>trni'�ss iuPnsaie GL-r:gptionlAglienttaral .^rindust:ial CIWs2trQvs.ity'Ulbasusing <br /> i CS Pr}slic WatcSysum .wr yu=a•. >< "�0nm�• +`s1°°f''6`+`:„� . <br /> sra�.raa <br /> Tva! _ Willlt(t>zI�w <br /> well. •L&epb t Well CI Wtli A xmtsovModituatorr G Otfier b orsa <br /> s otkwr."y�. ..G ComtiwLeit-al"_ <br /> �i.lJn/Ib1Tn$Wcll{s)`_.,.�OI w(3k .G Soil <br /> i✓ <br /> OLA•Ot-Seance Well G Out-Or-Service Well Renewal G Cross Cbanxc an Ae it s <br /> i O New Pumn, _ O Pa R lacement O Puma •r > <br /> Dr9lllag Method j(�Ma:Rotary CI Air Rotary G Auger G Cnl+)e TWl C7Y?uah Point CI Other <br /> Proposal wrcll Depth it Excavation„� in d:ameter G Owl 6attam �jravel Pazk t Gravtl 5rn in diameter � ^.. <br /> i � ^u Ctmsiw'tor Casln3 is diaretef i Ca:sductor Casing IXp'w __—� <br /> /(�'�,' G S e�' sac CI Stainless Stix:: CI Ushc <br /> well Casing D:a.•neter in rnicknssarGat: ASTM Sc}:ed�{?-Lsack mix!7 gal waw <br /> epthI . <br /> ' Croat seal D -,, .�-ft G Veal Ccnettt(4a th bag 15.10 ger;,+v„rr) n Saral c,-:'lent <br /> Narr» G Specs oa File C)Sptws Subrni:tad <br /> Stntomte <br /> 020%.solids) ❑Manntsa"..unf Spec°.;solids__I <br /> 1'''yrpett t7 Free Fall t3 Oihet Cl Itrta:daml Acrxie..tar inamei....._._..... '_... .... ._-.. <br /> ' Grout Plaetment Mnbod ._i ... .__.. <br /> { *pY}tAl, lnstaik-d By Ll Drtk: wrap Cmtfacto: C] O:h: n'Mick f�Chrisay Hax ❑Ssave Pipe <br /> 1 <br /> ❑Coatrea PedtseaS Dirorits'was'Width i-eni;:h C� <br /> { ',,,!•Sab.:lctsalhSc Ci Turbix G Onc� ..�_HP .......?ump Se:,_ - <br /> ft Standing Watsi.tvel__ I '� <br /> i I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL SF.DOVE'IN ACCORDANCE wrra SAN <br /> r.._._._.SOAQUI\COUNTY ORDTNAVCF.S,STATE LAWS,AND RULES AN RECLILATIONS t ALSO CERTIFY THAT MY 3tEQtjiRED LICENSE I5 r <br /> '•• CvRPXNT AND ACTIVE WITH THE CALIPOTL"UA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE Wt3'H ALL <br /> WORKERS COMPENSATION LAWS r <br /> • i <br /> MINVNIUM 2 OUR ADVANCE NOTICE P7EQUIRED FOR INSPECTIONS <br /> G /I[,L•1�1il./L T1711t`, DATE -.--•----- <br /> 51tuVr;Ii l <br /> i I <br /> I i � <br /> i i 1 I <br /> 1 I I ) <br /> � l , l i +i• l l ' I 1 a � i <br /> 1 I <br /> 1 <br /> i • <br /> 1 DEPARTMENTyli-SE-ONLY � <br /> Am IDS <br /> ( Applitadx Ao,.ea:cd BY t1 SPECIAL Well Permit <br /> Grout inspection 8 <br /> By mate _� 0 WAIVER Received <br /> Purnp lupxton <br /> Canstruma Wtii Depth ._.._...._. >Z <br /> t:OINMEm <br /> PE sC Recxtvtd An+oant ( Dau i PertrriU Invoice# Weil IDx <br /> i 'Cod” 1 lata 1 By Aemiued i Servles R crest o ! <br /> lI �02 $"•i <br /> I wEt;.vsnry vE;rur. <br /> ENb oi:+l-JGE , <br />