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SAN JOAQVrN COU?41Y J+NVRtONA�MrN Ilr�Ar is DRe RXmeN�rl./PUMP PERMIT <br /> 660 Itisi MAw 9txrtsi-3-roca7ox CA 95202_ .1583420 <br /> NON-1tErtINDABkEPExMt7' (709) <br /> C-AI 21193 9n-3-7697YOji)xipiI i-it7xNs <br /> l EXPIItES 1YPANFROMDATEISSUED _ <br /> aoRADnruu Qbl© CItYlL1P <br /> cNecbs Stalls r k APN <br /> QWNrx NAMri Q YrNcwg�ly/.-] L� <br /> OWNRRADDRI SS <br /> Crry/SrArrlL1P <br /> CONT'RACN'OK 0 S <br /> 1 uo <br /> CON71tACrOR ADDRuss <br /> CITYls1'ArFJZIYk <br /> sear-rrN1'ILLCTOK ' <br /> PHONE <br /> StMcONI uAl:'r'OR An6R!S4 <br /> CSIY/STATelz Q' <br /> LICENSE E]C-5'1 13C-61 ❑Ili tlxr - NUM.U.. �f �]�'] -- <br /> _ � E PIRATIONDATIE .11/407 <br /> Gl':OCRAPNOGv,1N1F()kKA'1'AON: Coordfpates 7( Y <br /> Towositip— Range radion <br /> IN'NxNDYU USEDomeshc1privam D IlrigatiordAgricrdtural 0 bulustrial D Wafer <br /> Q6atrty Monitoring ❑Scut SamPhngrCharncteriratian <br /> l7 Pubdr Water System <br /> Il'ddr�m..i fiam O+xicr: WaterS—N-L. CoxLW NarOea we umaa <br /> Trvr Or W ODK C7 New Weu 0 Rapiacem a Well 0 Well AftcratioNModification 0 Test Bole ❑Other <br /> Maa[aring Well{s} "`uhf 6rw`a" ❑Soil➢ s uuwau utUariog. <br /> °��() ❑Geotecluucal snmaeot Dorwsa <br /> Weil Dostrt CAW. Cl Out-Of-Seivix Welt R OM-Of-Service Well Renewal <br /> D New ftne f3PumrI Q Cross-Connection Ire ' <br /> W rr.t.COw'raucnaN <br /> DrBUng Method ❑Mud Murry CS Air Itolary _ ❑Auger Cl Calilc_Too[_-�Q PtkstrPosrd_(:l.4tlxr�-- - <br /> Prupoledlycd Depth ft Exeavationn in ditrrneler 0 Open Bottom 0 Gravel Pack I Gravel Sizediameter <br /> - � - - <br /> in <br /> E3Conductor Casing m dit meter f Conductor CAI Depth R R) <br /> Welt Casing Diameter_in Tluc;areialGaugclASl-d]Sci>cd ❑SUxt 15 Plastic ©Staines Steel 11 Other <br /> Creta Scall Depth ft 0 Neal Cemanl(04)61wg/S-IOgal wider) I]Sand Cement - <br /> ucknrix/7 gal water <br /> fl 13cnlanite(20%solids) I7 Manufacturer Spec%solids_% Name 0 SP=On Pile C3 Spcem Subautiod <br /> Crout P13amma Md4od D Pumped 0 Free Pall D Other ❑Retardant!Accelerator(rwme) <br /> P cunesr u- 1/4131104 By D Driller 0 Partp Contractor D Oftwr <br /> 0 Commit Pedestal Diumusiuuc: Width_tt Lerrbth fl Tlut;k in ❑Christy Bo= >a Stove pipe <br /> i4iscr Suhmeraibla ❑Torture 0 Other lip Pump Set it Stendurg Water Level "—li <br /> WRt L DYaTROCrNUN 17 Open Bottom ❑Gavet Pae}: D Uncured 0 Other <br /> Well Diameter in Total Depth ft Depth to Water 8 0 Casing to be Perforated frcmr B to R <br /> Seauog M:Itvrlal D Neat Cement(941b hug 15-10 gul water) D Saud Cement suck mer!7 gal water D➢entanitc Pellets -- <br /> D I3eruonilc(21)%solids) ❑MMwfactt=Spec%'Solids % Name 17 Spws at Fife Cl Specs Subuuned <br /> ]"Inge-PI Method Cl Pumped 0 Free Fall D Other <br /> D Complete With Musltroolu Cup $below grade 17 Cau+kte to Fr¢sdFS Surface Pad <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED TATS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE W17'Il SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND RECULATION9- I ALSO CERTII TDAT MV RLQUDiED LICENSE Is <br /> CVKRENT AND ACTI THE C CONTRA RS STATE LICITIBE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPE TION WS. <br /> 1UNtIN N124 OUR <br /> NOTICE [liEZEf1 C NSfE IQtiS /y/� <br /> 9AGNY31 TIT DA "/l/ <br /> l <br /> MENS <br /> --------- i------ <br /> c CD <br /> nod <br /> OUIN COUNT( <br /> pNM ENTAL <br /> DEPARTMENT <br /> 'DTMENT USE o Y rr <br /> Application Accyrted Dale Area <br /> Cnout htspmtLcn By 0 SPECIAL Well Permit <br /> Pump tnspccnwl➢y a' © WATVERReceived <br /> Dedruchca"' tion By to CesusnutedWeilDepth rt <br /> COMMCNTS <br /> PE SC Received Antoutt Pfrmtt/ — <br /> cod" Ido R Cash crafted Dale Ser-Ace Re Desi# lnVoI We➢ID# <br /> 2 <br /> 08 cv o a 7� <br /> EIB]4302-006 W➢B <br /> 9/1112007 Well Permit and l wIvatidadw <br />