Laserfiche WebLink
WELL/PUMP PERMIT <br />SAN JoAam Cama EwAwmwmaAL HEALTH DEPARTmEw 1048 EAST HAaLTON Avenue - STocxToN CA 95205 - (209) 4684420 <br />Mile <br />Cil O Cit 0049 0 <br />FOR INSPECTIONS <br />rArIKL. 'I TEAK FROM PATE Fi3UCu <br />CMOP <br />PAMCt3 SAM <br />- LAND Use APPLICATION <br />1�' �(1 4' -7 <br />C.ISTATIMP <br />'PHONE <br />\ 1!� I CIA 1532'0 <br />) <br />Zz �U <br />PHONE <br />C17WSTATEMP <br />PHONE <br />_ �CITVISTATZOP <br />Mlla6l .1L]Y_p� <br />ExpmroN DATE pq - 31 - 2---12 <br />DOIOnt:MkLLSAWLIM' O (3onortil WwaYC00011T1 011t0 (44ul) U t+aot) u r V=1 : kms. Qj <br />O hrl@wftVAWIc& M 0 MfdwtrW ❑ Wdr awry &4mborirq 0 Shc SwripIrVCheradertubm <br />edrwal Yr O NIIhr o"bm Neer Carad Nm of Phar NurMr <br />ffiarwom Nm%044 RRaplaosnwd WM O WM AMeratlonn IOD u Uawr <br />6 MadMbS Wd(s) _ E at Waft O SOI Borbvs) od6w p 0 Geotechrkal <br />0 Od-OIirMM WON 0 Ou44"orvim wd Rww d O Croes-CowAction Repok <br />r d Dao <br />O M.9 "hed'I'b/ a Air Rly 0 Auger 0 CoW Tool 0 Push POW a 07 <br />Pa�PwaO / pgdt Q_It E...11ml'— In dlmnr 0 Open 8dton ❑ Gravel PadJOravel Size AXV—in diameter <br />O Ca ft IM dandy I cw4ucbr Caskm Ono R <br />Well Cribs TW&mEG=VIAffMSdtad /1"0 Q_ O Sbal vbwe o st rdm steel 0 other <br />and SMI A a Ned Cowd 04 A bay5•10 gal 8MM 0 Sand Cement sac* mixn gal water <br />xOwBud Nes cmadds) O Ortr <br />pbom M MoMad O Fna FM O (Star 0 Rdrdwd I Aooabdor (name) <br />MWAK@d y 0 Dl9w 0 Pane Cotleaticr ❑ O0w <br />a Comob tid@M : Wirt R A Thick in 0 Chdoty Box ❑ Stove Pipe <br />O 816lrnndaO Turbbw 0 Odw HP R Standrq Nater Level R <br />1 ww"T CMWT THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE W ACCORDANCE WITH SAN <br />dDAaLMI COUMfY M MAM IM STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CUE ff AM ACTH! V= THE CALMOW" CONTRACTORS STATE LICENSE BOARD AND THAT I AM W COMPLIANCE WITH ALL <br />W01 N coww"TLON LAMES. <br />llm � � ADVANCE NOT fiECIIJIREIT FOR INSPHrTiQNB - PLEASE CALL TE 95, -7697 <br />VA- <br />(-�( ��Y- � Owuk/y.. DAT! meq' VA - bl <br />DEPARTMENT USE ONLY <br />AMa)tlsdy ��—� L� t Dab <br />OsMd bwpdkM y r� } �rt� Dab 1 <br />PW* ti0w y Oda <br />Sall Be" brpaaSaM or Dols <br />Comm�� Jfl'3.11^i -v1"l) ' r Cc1 %,^ ivJ <br />r' 11. !. 1;-1~ l,T r <br />Area <br />�� % Flrrpioyse IDK f_! <br />0 SPECIAL Well Permit <br />0 WAIVER Received <br />Conatrucld Well Depth 1 <br />REcYMFNF� AFD <br />FP?� <br />2021 <br />-ti Q/ <br />N <br />-V <br />EHD" tants C�Sx�-- _ /,� 1�- 0 / 40 ksti'�" <br />