Laserfiche WebLink
WELL/PUMP PERMIT q5 3q 3- G o2 <br /> SAN SOAQOm Cmaery ENnsIONMIXCAL HuLTE DVAEr al 3041 E WBga AVE 3"FL-STOCRr0N CA 95202-0")41611 <br /> NON-REPUNDABIE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JDBADBEW 3071103 S. Ma[.at-Avr Drive CIWMP c 377 _ <br /> camessrEESTWC5L1 Lig Rynd APN 253-80.190 PAucuran 3S-37AL. Uxx APPLIEATim ° <br /> OWNER NAME 719 G hf T�e-,4 L- �-�E O✓EG SNe. - PawnOwlet wmRug yoG U S3 Ptr CW 537 CrrY13TATdLr W <br /> C(� Car <br /> CatrRAcrOR Kle�1iJeWtit, rWc Fact, a09�91/8'l3'yS O <br /> CQNTwcroxADDwYuo�001 Arnt�e-Aireet+ Reft� L7TVSrATe/7Mr SioeklD^/�A/9Sa04 <br /> Sue00NfRALTOR I.tnn"I9e✓' I1f IIiAG PEa+�ed I) <br /> SUBCONTRAROR AOgpax l73n HGrt,r.j^cC Dr. CITY/STATEIZir <br /> LK usE C-57 III C-61 13D.09 OOlhu N..R(7350`I EUIMnbn DATA O <br /> CacRAMRCAL WP04UTTON: Co°rafn.w XazAn92R YyaI.q=s Toemallp_ Rv°ge SMdaa_ <br /> IxrwOEe uxe ❑DomesticfPmuc 171rtiptioulARlcultuml D Indusbial O Wwr Quality Munitoting Soil Sampling/Cba scOginOdn -S <br /> O Peblic Wam SYpemn <br /> ItdiEsm$Ram D.m: .-----E� rr�`— <br /> C <br /> Ten OF WORE ❑N.Well O Re0ltoemant Well ❑Well Almration/Modifiation OOther S <br /> ❑Mwitariag Wdl(s)_E ofvmlls E3 Soil Bonng(s) tof t.nnp Xaemmhnical qaratP <br /> ❑Ouv0f.Sr Sot Well CI Out-OI•ScrAce Wcll Renk Ll 0C.Coo.g.Repair V <br /> O New Pump O Pum Irimlat IS Poutp ii <br /> W[LL CoeumuccTIDN < <br /> Dlilllag Mali O MudROIHy 11 Air RMsry ❑Auger ❑Cable Tool ❑PA Point O debt P <br /> Proposed wed Deab 55 AQ A Egcaesdoil1N ✓z id diameter ❑Open Bo:bm 13 Grerel Pk I Gnvel Six le dwaucer <br /> O Cmducw,C.ehng in dismcmr / Co w!u,ow Cming llap h D <br /> Well Cage, Dismmcr_m Thickvns/GaugdASTM Sched 11 Slcel O Plulic O Smieku Steel ❑ONer <br /> Cteut Sed D"dt R 11 Nat Cement Flt N bag/3-/dga/wM/ 115tH C., .task aux/y p)water <br /> ❑Bmmnile(20%solids) ❑Manufioor Spetc�%�solids % Name,.2� OSpeeson File 11Spms Submived <br /> Caul PMeemenl Method O Pumped ❑Free Fall I%Othr�Cill iFh:(.W ❑R`F&tlfm'l ee�cr.mt • )[r-....c�- <br /> E@EICek lut.lkd By 11 DAller ❑N up Con r tur 11 Othr_ <br /> ❑CoacnM Pedahl IHe t.I.a:WMIk A Lagth R Thick O Ch lety eta 115rove Pipe <br /> m <br /> Puar ❑Submeaibk OTutbioe 1101haf HP. tamp Set BSwsding Water Leval R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> IOAQUIN COUNTY ORDINANCES STATE LAWS,AND RULES AND REGULATIONS 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> _ MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS y 1.../ <br /> 111119 Tiruc o acr- DATE /•• X08 <br /> 1 <br /> A <br /> M TP <br /> DEPARTMENT US NLY <br /> Application Accepted By L Ara Employs IDp <br /> Grout lospeador.By olR ❑ SPECIAL Well Permit <br /> Pump lnyectiaa By Dab; ❑ WAIVERR¢eeived <br /> CensOulltdWall b / It <br /> COMMENTS o �{ �. /Sh,1 <br /> —• <br /> PE K Radeod Chaeta An41uM R <br /> Cada Info B s RemitMd Dale ..at1 aE Wall IDY <br /> nz. 1,so 32b $ 3Ic.1n7 1 r1 <br /> aDlLeleM WELL NM PIAMIT <br /> MIME$ <br />