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WELL If PUMP PERMIT <br /> KAN JOAQUM COU ENVINONMENYAL RLLLTM DEPARTMENT .IOEEWVHfRAVEY'PL-STOCK CAH202 -(209)46"20 <br /> NON-REFUNDABLE PERMIT -7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADWTSB aw/m, ✓ <br /> CROM STREET '/�• APN� i -O PAWELSI= NDUEEAFNJCATION11 <br /> OWNER NAME 1 h VN III A& PHONE Pq <br /> O"ERAODRM — e O CmBTAMVP •' � <br /> CONTRACTOR UI461'/ -t�-'� PHONNE�E SCF]/E)—(CI Y <br /> CONTMCTORAODR[S4 CfVVAITATEfZV -Z.= <br /> SUKON FAM R PHONE <br /> SUKONTMCfORAODRES CT'ISTAT"IP <br /> LK E C-57 ❑Cdl 0D49 OGNer NUU19R72.Qc,(QEXPIMTTONDATE <br /> GEOCMNIICALINPORMATTOn: CaorM.M X V TONMhIp_ Beep_ Snob <br /> INTENDED USE O Ofipliw✓AVicultunl 0Induflnad O WEur Qwli"Manitoring O Soil Srmplms&lrncla.'..n <br /> 0 Public Water Syyaum <br /> I7M1Rwmt ham Oww: em Ta.n Wne e..sO — <br /> WK OF WORN ❑N.Well ❑Replacement Well O Well AIIeallaoIMOMfiation ❑Tesi Hole ❑Other <br /> O Monitoring Wella) Bof calls OSoii Bonng(Q •ofpotlrip OGeouchnial aomvny <br /> O Well Desi uon 0OutOf-Smia Well I70ut-0f-Smite Well Reo.l <br /> 0 Ni,Pum, i(Pump R lrccmeni 0 Punnp Rcpmr ❑cam connection Rcaa <br /> WELL CONS RUCTON <br /> DAuing Method 0Mud Roury 0Air floury ❑Auer 0CNlc Tool ❑Push Poim 0Other <br /> Frepmee Well Depth R Psawdon in diamHrr 00P Banem 0GrsNel Peck/G.rOl Sitt in Alamelc <br /> 0 Co 1.Camng in do.. I Conclue.Caring Drplh R <br /> well Using Dlamrta_in Thakna✓G U WASTER Schr.V 0 Stat 0 PIMtic ❑Suinless Stat OOIhn <br /> Croat Seal Dep:h A 0 Nat C t(9I/11 hog15-10gal weer) O Send C., nul,nv 17 pl war <br /> ❑BntaniR(20%solid) 0 MMuficu e'Spa%.hds_% Name O Speer on Fik 0 Spee Submitud <br /> Grout Piaeemeat MHhod 0 Pumped 0 Fra FEII 0 Olhcr O Reukant/A<akNata(Mme) <br /> PEDFSfNL Immudw B, 0 Dnlla O Pump Conlan 13 011n <br /> ❑C..W.hde l DiENMbM: Width ft Isngth ft Thick in O Chrisiy BOT ❑Slave Pipe <br /> PUMP Submersible 0Turbia DOthn HP Pump Sct fl Surding Warn lrvel ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN 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 /> MINIM H�O(U^R ADVANCE NOTICE FOR FOR INSPECTIONS <br /> SN mw > irate TITLEY I��/ DATE <br /> r <br /> Of <br /> LJ <br /> 71%i <br /> - - DDE[PA9 14 ENT USE/Q�N LA' ---- ---- --- <br /> Application Accepud BY �/1-4- OEM AL Employee Ipl <br /> Gmm Inrpmdan By DewTTET ❑ SPECIAL Well Permit <br /> Pump ln.Voeo..R :Zw Dew Is f' 13 WAIVER Reeelved <br /> sp <br /> i <br /> OMu Inection BY Dau mated W/ell�Depth R <br /> COMMENTENT S <br /> PIE9C Raeslwd A..Mt 0.4 P.Hety levBkn/ Well IDE <br /> Caha In4r R Y ■ed1Md SeMaR sM/ <br /> S-211 bk P69pt pO 1 <br /> ENOI)LS Va WELL NMr PERMIT <br /> ueM <br />