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INELLIPLIMP PERM T <br /> SAN JoAQMN Caun1YENVIRONM2Mt_HEM-MDEPARnO-Vr 1gsa EASTHAzELTaN Amur:-Srom=.V CA9705-(209)468,U20 <br /> MON-REF=Aet E PERmT CALL 209 953-7697 FORINSPECMONS EXPIRES 4 YEAR FROM DATE ISSUED <br /> cmla,Linden 95236 °' <br /> d0d ADnRas <br /> LltasssrR�TC 1 em n fi S R r� APN ��PAncsts� • IJ tarmUsEAFn>JCArton� <br /> OWNER HIALSE R p T Fa r-M <br /> --� PNat-209-40'1-4K6Q <br /> Ot.ERAODRES'S P.O. jQX-171 CITYIS dmP n4e^r-L --� <br /> CONM,tCTOR Purviance Drillers , Inc PHaV.- 209-887-3554 <br /> C0.'nRAcmR ADDRF35 PO Box 64 crrYlsrATFraPL I n d ern, C A 9 5 2 363 <br /> ISURCaNTRACTDR Pmors <br /> 1:,--'C--E <br /> WRACTUR AuVRISS CIT ISTAmoP <br /> rt CS1 U C-6i C D-C-Q 0 Other NumEER 3 7 7 9?3 ExmAmaN DATE 7/31/19 <br /> Oar�s��TRraiSa�PiQ1�D General WrierailCo@Iolm Bacteria(4391)_BFammachloMpMpane(4392) Amenic(4393) <br /> INTENDED USE ADomm TrJPrivate G IldoafconlAgtitultural C Indusufal G WalerQuality Monitoring ❑Sal S2 npl'inglCharaderbratmn <br /> Pubti=WalerSystem <br /> QdiRetest@am4lmer. W�erSyttnnn�ry Can=Mn=arPnn=Nmnner <br /> TYPE OF WORK C NeuWen r Replacement Wel G Well Altvzt!lon1Mcd1firaticn 3 011ier <br /> MnmmringWeli(sL_�aferzrLs GSell 80mtg[s) notes"- CGeolechlital =otneer;s <br /> G Out-0FSenn®Well I:OuI-O SPrdim INe2 Renewal D Crass-Connection Repair <br /> G Nea Pump Futnp Re t;ement E Pump Repair 7 ReseWall Casio <br /> VVn1_CaNsmucnaN <br /> �tlrlliingbtethod O Mod Rolary r-AirP.utzry 7 Auger -0 Cable-tool 7 Push Point _ Olher <br /> (Proposed Well Depth ft E=3vation in diameter =Open ILattom G Gravel P=VGravet Sme in draneter <br /> G ConduclnrCasing in dmmeler 1 ConductorCasm_q DFplh Z <br /> Well Casing Dimneter_in Tnidmess1GaugelASrM Schad ' =Sleet 3 Plaslic G S'2fmles Sleet D Other <br /> Grout Seal Depth_ft ❑Neat CemEnt.(94 10 6ao540 cal trato 3 Send Cemant sack rmlT gal ester <br /> G Bentonite(M%sn6ds) D Other <br /> GroutPlacemenMethad E Pumped ❑Fres Fall '3 Other 3 RelardantlAttzlaatarim me <br /> Pm>srAL Installed By ❑DrQler .3 Pump Contractor ❑ Othv <br /> G Concrete Pedestal COlmensinns Width P. LengOt tlThldr in D Christy Hat D Stave Pipe <br /> PualP *Submersible❑Turbine D Other HP Pump Set ft Standing Water Level ft <br /> 1 HEREBY CEFMFY THAT i HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE GONE IN ACCORDANCE WITH SAN <br /> 1OAQUiN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS_ I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITFI THE CALIFORNIA COWMCMRS STATE LICENSE BOARD AHED THAT I AM IN COMPLIANCE WITH ALL <br /> WO PEQSATLON LAWS_ <br /> 1011111 24 HD CE NOTICE REQUIRED FOR INSPECl7C3N8-PLEASE CALL(209)953-7697 <br /> Slur- corporate SecretarffA, 2-q)'T <br /> III Ilii IFFTT IM1111iiRM11111 1 II <br /> -77 <br /> II II II IIl I 111 ! I <br /> Illi I I I I I -I ! 11 Il <br /> IiI I Ilt ) I Il I1 Ii if <br /> IiIl IIi Ili " i <br /> IIIM1 11111ilIIIIII ' _ MIVED <br /> ! ! 11 I ! ! II I IIII l• <br /> I l l ! I i I I I I I i I I 1 1 I f i D li�iy <br /> . 1111 11 111 [ 111 i 1 1 1 1 11 ! ll I ! ! II <br /> I I I I i I i I 1 ! I i ► ! <br /> I I SIN CCS!i1VTy <br /> Niv!FN-FAL <br /> I I I ! I I I I r IFIK 11 IDE-;RTMENT <br /> rl t\p ARTIttENT E LY q <br /> r <br /> Application Accepted By Date �� 1 Ana Z4 EMPlayee IC*AA` n' <br /> Date O S ctaLWell Permit <br /> pumpinsperbonBy �G+u,.S L �:� '+ •">,. Dare 1C O WARIERROC97 VQd <br /> Sail Baring inspection By _ Dale Constructed Well Depth R <br /> COMMENTS <br /> PE SC f;�caived Amount PermiU Invoice: I _ -We-_. lift. _ Ca2tt'._---Hemttted _ wice Request <br /> I <br /> ! I <br /> I I <br /> e1-..1rFU.P PERbtr <br /> EvDa^'a E9rrs <br />