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WELL/PUMP PERMIT <br /> t <br /> SAN Ja-%Q'lN COU.NrY DEPARTUEIT 666 E A^+r}ftm STREET-STOCMFOmV CA 95202-(:09)46$•3426 <br /> NON-REFUNDABLE PE AUT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 'JOP ADORGSS 3iU_44demlr���g�a;�4-v't. Cmfzw - .;gAte !� <br /> CROSS STRELT Tracy /' -r _ APV d3SI0013 PARCEL <br /> n'`i <br /> OER NAmE SRffi✓/V�S 6-(1,V Z/ )� <br /> ,Tv( Puo�e <br /> ON!.ERADDRES / <br /> /7 /��1�l/ CffY/Sl':1TFILfP , <br /> C.OKtRaCTOR �V�� -/ (I� LyL J G� Y _ PHONE <br /> Sl�1eCORTRACTOR PttO�f_ <br /> SURCO''TRACrOR ADDREw <br /> LICENSE O C-57 -6) O D-09 O Other ��� NU tOER ESPIRfifM D.sTE O i ZG <br /> GEaGR.wHtcNALl%FOlLN.%n0%: CasrdhRtes X } _Tewuhip, Range Swtka <br /> LNUADEO M Ptivx O Irt p1—Aguu1U" O in11D91131. Q Wv=Qmh y SSvautisg 13 So i 5araptiR=C>aa*�d roD <br /> O P&IC —System _ <br /> 6'dJAK.:a frm Owwr: wr s'—'. <br /> Cccma Nam;.cep tact vumd7 <br /> TYrc OF Wows w li'zii epltcxtxnt WeU O tt'ell Altera imA"'Icmioo O Test Hol; O Other <br /> O Mauituring Wells) <fa O Soil Bating(s)—_ ^mbr.,eheTng; D Ge�crhni l saiecr.,tb.#ga: <br /> t3 111,11 IkstnxGon O Qot-0f-S&:vice wdl a Out-0i-Scnic,Well Rcoc%J <br /> ❑V.'w' Ruofac-ent O P R.-pair ❑Cros3roam-xtion R-apair <br /> WU-LC0.%STREC"'-1, 1 <br /> DnN"Method 4uJ Row 0 Air Ro a y ❑Augu O Cabic ToW ❑Posh Point O Other <br /> Proposed Wel Dcpth _ft Excavation in diameter 13 Open Bottom O Grovel Pack i Gravel Size in diameter <br /> O CottduCW Caning in d)anuUr c Conductor C usiag Depth ft <br /> n CH Casing Diaro la_i t ThidVcs-`Gauge.'ASTM Schell _ O S:zzl O Plastic O Staiukss Steel ❑Other _ <br /> Grout Seal D,,,rA tt O\cat Cement rYs ib bag'3-logo!tines) O Sand C xnmt iNrk err&;7 gal N'elCr <br /> O 9mtonite r20;soiidsy a Slaanfacaurer Spix".F o)ids_ , %arc O Spws an Fab O SpwsSDbm)rzd i <br /> Groat PWec+ent]iethod OPtumped OF=Fall ❑Other O Rclatdatd:Aurlermor(same) <br /> PERF-ST.AL )astam By O priltzr O Pump Contractor 13 Other <br /> Lt Concrete PednW Dimm*ns: Width.ft Lcoeth_ft Thick ❑Christy Bos O Sroce <br /> Pump Stbaersihk (3 Turbine OOtbes ` HP PttW&, r StandingWaSerL.,61 R <br /> WLLL DLl:rRuCTtO% A Open Bottom O Gravel Pack 13 Lacascd O odd. ) <br /> Well Diameter_in Total IXpth^_tl Dcpth to:Pater_ fe O Ging,to tr Perforated from R to_ it f <br /> SeaU*g Materw O flat CCw tt e941b 3rg:3-IDS:/ruvrx/ Oland Ccnwn: w t md­7 gal wxer (3 Hmtonite Paf" A <br /> Ct B,-mmitr i?6se soil) O'.N.vtafartumrSpn`ser swims °„ .am O Spas on rrl: O I <br /> 4 Ptaeemeot Method 13 Pampod o Frre Fall 13 Other <br /> O Cou#mr ith Mushroom Cup ft bciow grade 0 Complete to Existing Surface Pad <br /> !HLREBY CERTUN,THAT i HAVE PREPARED THIS APPLICATION AND THAT THE WORK RTLL BE DOVE LV ACCORDANCE WITH SAN <br /> JOAQUEli COLNTY ORDINANCES,STATE LOWS.AND RULES A3M REGULATIONS. I ALSO CERTWV THAT WV REQUIRED LICENSE I.. <br /> CURRENT AND £ CALIFORNIA CONTRACTORS STATE OCUNSE BOARD AND THAT I AM Lei COMP[a WNCE UUB AiY <br /> WORKERS <br /> co Sq A(✓Oq Q ?000 <br /> Stri.YED <br /> DATE <br /> 44 <br /> NT <br /> LA I <br /> 'MR <br /> DEPARTMENT UF 0-*y <br /> Amb,tial Accepted By ��L L Date 7 .7/ o;io Am 5 e Empioycc JDA,•��-- <br /> GT.Lri bup"clion By Date Q SPLCIAL/WeitPer•mit <br /> PwnotaspcctionBy ;IV70 =, 0.111pty_ Q N'lAIVERReceived <br /> Destruction Inrsroo�xtion By Da' 1 LogMry�t�a WeU Depth ft <br /> COMMENTS ♦YrLel L-VG i IPS r— P111�� WGl�f_r, :�/,�11�n .r/tl/ Vf 7,L:G j• <br /> Cedes IRC PE SC <br /> Rreds Asuouus, Drat Penow 8 IRvMrrH wtoW#Caw Resifted <br /> ` <br /> 1 050 t <br /> EHD 43-02-M WEB Wel!Pertut and©x t ram-d m <br /> 9%t!�Yt11T <br />