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�'°N WdL�C:6 floZ 'Z('AoN ;Wli paAI;3;� <br />WE! UPUMP PERMIT <br />SAN J tvtarvu Codrm Eu-n,4I wEkTvu- HEa>_n+ DEPARrtawr 1868 EAST HAmroN Avv+UE - Srocicr .'d CA 95205 - (2l19) 468-5720 <br />FOR <br />PIh(tb 1 YEARFRUmt uArt <br />sr— <br />ot1F_LS Cm1Z2m_ <br />LwW LLE APPUr-A'nCW <br />NAME PH ON -i <br />c C� <br />AoDREss 15, }� - �� : ,� c� c _ cnv,5'rA'rEJZIP 1,-\ <br />�GTOR <br />Purviance Drillers, Inc PKofv=2n9-887-3554 <br />acrcRAaalzEss <br />PC) 'Box 6 4 CrrY,sr TEfZfj i n den' C A 95236_ <br />SuacowrRAc on A=REss <br />LiceLsE n C-57 a C -s -i_ a D -f.9 D <br />P <br />Ct'n'15TATE ZP <br />3 7 7 9 2 3 EXPIttxnclN DATE 7/ 3:/ 19 <br />rinr.icr;-nr lflf r i coup, mc_-(,-P-nerl Miner2fICcIforrn 6actetia (4391) = DtibmmachlnreproPa"le (4392)-Arsergc (4392) <br />NTUMEO Use 0 ComesttJPm2lc C IrriguconfAgdcultural C Indusldai C Water Qua4tytAonitaHng O Sol] SampliingfCharaotarimtion <br />Pu6.m Water 5yritem J <br />tffammafrm Caner lMerS}4em t� eaY.eG r2 ac ar Ptm r-N'cm�r 1 <br />TYPE OF WORK D Neu Well C Raplac ment We C vvefl AllerdiaN0.7ocSeedtiwl 3 Other <br />D kgtolatork.,gWell (s)#of%%els G SWSoiing(s) Zacorir, C Geotechntal <br />C Gni-Of-Service W/eU— O Out -Of Semce Wel Rertewz 7 C=-- Connection Repa(r <br />..-�.....� 1c+Pinnn t?�nfarvmPnt r, Purno Remir 3 RaiselAIPJ CasinU <br />a or Cxrrgs <br />'DrIkUng Method O MW ROtarJ r. Nr Rotzy ] Auger 3 Czolc Tool 7 Pash Paint rl Other <br />Proposed Welt Depth ft Exca=Gon in diameter = Open Bottom C Grave! PacklGravel Size in diameter <br />0ConductorCasmg incrameter I Conductor Casing Depth fl <br />Weil Casing Diameter _ in ThidmesslGaugeJASFAr1 Scher! Sleea D Plastic C StainlessSled '3Other <br />smut Seal Depth >i .3Neat Cement (341bbadrf0caftrater) 2Send Cement sark-Mbilgal water <br />C BentcaiLe C117°b solids) J 01h er <br />Ir:—1 Pfaromant llirlhnd T: Pamrwll 77 Free Falk 101her 'u RetasdarltlA.rmrdaator (mune) <br />Pm27ral In5mlled By G Crgler D Pump Ccntactcr D Other <br />C Conorcae Pedestal CDfinenslons: v✓ctn ft LengthR Thick in -IChristy Eos :D S(nve Plpe <br />a m 9 Suhmars DreC Turb'1e D Other HP �/� PUmp Set It Standing Water Level i <br />i HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND r MAT THE WORK %%IL.L 13E DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNT1r CRDINPNCES. STAT LAWS, AND RULES AND REGULATIONS_ 1 ALSO CERTIFY THAT MY RECUIRED LICENSE IS <br />CURRENT AND ACTIVE VATH THE CA!dFORlGA, CONTRACTORS STATE LICENSE BOARD AND 'MAT I AM IN COh7P1IANCe WITH At I i <br />woia�0PIENSAl1ON <br />( MIN l 2 11 AAlCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209) 953-7697 <br />s,4© �, 74orporate Secretar&, //-�-�� j <br />ME <br />&�EMM <br />FAME <br />■`1■■�■■st�:�■►L'u■■�■001■■■■NIRA■ME <br />■11■■■■■■■■■■■■■■■■ <br />■■■■■■■■■■■■■■■■r:■■■:■■:,��rx■■■■ <br />1n■■■■■■m■■■■■■■■■■�u■■�n <br />01079"NEWWWO <br />IT!EMN, <br />�.■��■■■■■■m <br />■■■�r■■■m <br />■ ■�� <br />MMMMMP-MM= <br />■■■■■■■■■■■■■■■■■■■■ <br />Grout Irmpectian By <br />I■■■■■�■■■■�■�■■■■ <br />■■■■��-�..�.. <br />■� <br />�■■■■■■■■■ <br />Pum InsPa=5on 8Y � <br />M■■■r■■�■m■■■■■m <br />■Ems <br />m■■--■■■n■■■■n■f■■■ <br />�■iii■■moi■■�i■■ii <br />�■�� <br />B■■�® <br />+■■A■■■i■ <br />■■■■■■■■■ <br />Consimeted Well Depth <br />■■■ca■■m■■■■■■■■■■■■■■■■■■■■■■■■■ <br />COMMENTS <br />I■■■■■■■■■■■■■■■t■■E <br />■■■■■■■m�ME <br />■n■■■■■■■■■■■■■■■■■■■■r■ <br />■■■•m■■■■■ <br />m <br />a <br />0 <br />{a <br />b <br />PE SC Receivod Cttedof Amount <br />Cod.. sinfo- -- h _ Remitted Lace: <br />- - <br />DE ARTMENT> U E NnLY <br />Gr A 0 <br />( <br />Area Employee lD.r <br />Application Accepted By <br />V am <br />I <br />Grout Irmpectian By <br />Date <br />J PECiAL Well Permit <br />Pum InsPa=5on 8Y � <br />�C``��yQ� Date <br />D iflfw R Received <br />Soil emittg tmpaclian By <br />Dale <br />Consimeted Well Depth <br />It <br />COMMENTS <br />m <br />a <br />0 <br />{a <br />b <br />PE SC Receivod Cttedof Amount <br />Cod.. sinfo- -- h _ Remitted Lace: <br />- - <br />-Pe rnitl (nvol�"reU Mg <br />Service Re est» - - <br />c l <br />I <br />i <br />EMD4 -c: zornc <br />(' � S�4707 23 <br />Ed t19U9960Z OUB Saajji.lQ eOUPlAand e9Z:0� 2L Z� AoN <br />