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T^ � 10--�q—IIsVLr-\S610 '0N WdSO ti 9M 'H '130 anvil paAI ;3q <br /> WELUPUMP PERMIT Z <br /> SANJOADIIN CWXTYEWRmnaer RiiA1THDEv9RTNENi 1868 EAST HA>'E_TON AYBRUE-STDg1tTOR CA 95205-(209)4665420 <br /> NON-REFUNDABLE PEW CALL 209 953-7697 poR INSPECTIONS EXPIRES I YFARFROM DATE 1SsvE0 <br /> JOa ADDIUM 152er P-d a, arLinden CA 95236ig <br /> CRM STREET A r c h e r R daPN105e610,91_, <br /> _PMCFis� LAND U4E APPlSATPN# o <br /> Ow RwBg'ittalia Ventures PHME209-941-4500 <br /> ONHEn Ammons P -0 _ R n x 1 7 0 CmI5mTE2o• T.i n d p n C A Q 5 9 3 F <br /> CONnaaemR Purviance Drillers Inc. Pea 2019-887-3554 <br /> cQATRACTLRAoD z P. O. ROX 64 CM)STATElZP Linden, CA 9523 <br /> PHCNE <br /> SUKONTnnC7Dn ADDRESS CnvfSTATvsmP <br /> LIceM..E a C-57 O C-61 ;,0.09 _Olha NuMRet 3 7792 3 EX TION DATE 7/31 /17 <br /> GEwRAPN1dALiNTonemnON: Cwrdinates X y Townshlp_ Range_ Soctlon_ <br /> IMlHiOED USE L'OmlesaclPrfvele r adgagaNApiculNral C I[Meelrfei _Waky Ouality MONtorM D Sal S <br /> g amplRplCnaradedratlen <br /> '.,Public Water System <br /> -VWWKpusurerem asrnoAner. sa anw on arcar univer <br /> TWE OF WORK ;J New Well L ReplarEmenl Wel UWe1NRdatlonlMMifiralian JOgrer <br /> -:MonibdnB WNI(s)__tlof welts risaleodv.) enlbnmia -Gacsochtd.I •arwMys <br /> rt DrnOl-Service vde11 n Ow-OLSmAoe WNI Reneuel r Cmss-Connectkm Rtpair <br /> G New Run R Pum Re Iaparanl C Pump Repair I_Raise well cash <br /> 1�1 CONSTRUCnEIV <br /> Drilling MRlheel Mud Rohry L AlrR.Imy J Au <br /> sar �Cable Tool :Posh Point � Other <br /> Proposed Well Depth ft Exr:ava0on in diameter C Open Bottom C Gmrel Pa GmvN Size in diameter <br /> _Cmldudor Casing In diemeler I Condudor Cnsfng Depth ft <br /> Well Ca61119 Dismeler_in ThirkneselGaug&ASTM Schetl c SIeN O Pls9 [Sleinless Stee O D,,K <br /> Grout Seal Depth ft UNeat CemetaWfbDaVyjogaluale,) OSand Cement sept/mislTgai water <br /> IBemmnlle(20%softs) rt Other <br /> Grout Placement Merlad C Pumped :;Fee Fall a Clher I'Reunawl l Acxelemlor(name) <br /> aU13TAL 0 Driller G Pump Cnlmador r Other <br /> u Concrete Potaaml�Dlmenstonc:WiW_n La M R Thick M I I Cndsty Bos L stove pipe <br /> Pu— uSubmersiNes Turbine it Other HPL_ Pump Set ft Smndirg Wafer l_esel It <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORT(WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES MID REGULATIONS. 1 ALSO CERTIFY THAT MY REOUIRED LICENSE IS <br /> CURRENT AND ACTIVE PATH THE CALIFORNIA CONTRACTORS STATE LICENSE 13DARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKEP SATION LA <br /> ( MINIM 2 OV Cr NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7 <br /> SIGNED TYnF Corporate Secretes �_ <br /> I <br /> IV ® <br /> 20161 <br /> H1111 -H41 I <br /> irrgtRw�U771 <br /> 1 <br /> 8 � <br /> 1 <br /> � rt <br /> 1 $ } 2 <br /> EP RTMF NT USE NLY <br /> F <br /> bo <br /> APPIGnsutInsgepled8 Dale Atea1�9� EmPIDYDe 1D#- 1' O �Fm <br /> GtDat Inman By Dam 7 SPECIAL Well Pemllt ; N U Z M <br /> Ptsnp lnsPEdior'By Dale 7 WAIVER RewiYed W =, rN Z Ly Q <br /> Soil Boring InapectIm By Daze Certstruc0ed Walt Depth K W E5 p W <br /> MMMENTS /' U <br /> Q 111 U a 5_ <br /> Q a' O q z <br /> PE PAte ed �Cpp eIh GT Amwnt INm id Z Q <br /> Cotler Info VtwsRaNhea Wts Service ucR# Invoice# Weg1d1 Q W <br /> Sa 1374 MW7607 a 0130 U <br /> Eroa5a4 weu muco fFnwr <br /> wwrz <br /> Zl'd tL9£L9860Z outsaepi)Qeoueimnd dS6I, ZOOZABN <br />