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WELL/PUMP PERMIT <br /> SAN JDAWINCaMO'ENIt KE1RAL HEALT1 DPrARrMIXf J(KEVimRm Avt3"FL-BIpC CA957g7 -(i09)46uw; <br /> NON-REFUNDABLE PERMIT CALL 209 9-93-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE IMUED <br /> J.A. I/PN -is(�t ( `!O �CKID'JllP <br /> s <br /> Cn9a SNlfLT APN�/J/—/f'//J -/1Z PAXCF:L9¢E <br /> 0"iui N % 11 r PnmvE <br /> O"M ADD. m /S IOD t. C./ftA.'a, <br /> CDmmw ,t PHONE <br /> CDNIiNCf OR A...EFi GIIYIBI'ATVbPL-.-k GraFni, <br /> So.LroIRR mm PnDNE J <br /> YueCONIwCR <br /> �rD�AD.nYM_ CmRtA'RIIJP <br /> I.IEIDV&E X1C-51 sl 0D-09 000e NUMSEg ExnxATtON DwT' ` `` <br /> G.0(SAPRI4L Inp.MAT : CAorAlatw X Y To-"Ip_ ft a._ gago. W <br /> INI®m®Un ODomwdr/hiv.m nTgm/AgtiwhuW ❑hdnaw ❑womr Q"Ry Monitoring ❑Soil SenrylinOYTantcmiaCOn �(�, <br /> ❑Poblic Weer yin j 4 <br /> TYPEov WOXK ETgc-.Wdi ❑Repkw We ❑Well Alteration/Modlge.rioo 13T flole ❑Od. <br /> ❑Mmianog Well(.)_ �ar ❑Solf Boring(.) pOdf OrbN� O CieotecW l <br /> ❑Wdl Des =w ❑oa-of.scmw Well ❑Om-0f-s"r Well R .l �+f <br /> ❑New ❑ lumrcot ❑ ftit O C..Cam m w <br /> vi t CONrtRUCDON <br /> DrOgK Method O MW Racy��/��A ❑Nr Romry ''❑nnA''ur Cabie Tool /❑'Push Pm, ❑ONv <br /> Propomd Wen Depth V2 Vfn fk luaus. &.. 1.'Opea Broom C3 U .l Peck/O vel 9 k <br /> w tlfmneb <br /> O " dkmeer / Cwdu�emtr G000sing DN1s f R <br /> Wdl CAdng Dvmemr 1(L I. T .WASTA1 ScW_JL— ❑Plewa ❑Smini®Steel omn C� <br /> Gr.Ot Sm1 Dcptth y f R ❑Nn C� t,P ib hq 15-10,W vaerJ M'Jrad at�ss2s4/7 pl san <br /> ❑Brnmnim(JO%aib) EI m0ehue Spec%.lido_% N� ❑Spm."Rk OSp®Submioed <br /> Gro.t PW l Mdhod M'I,ap.d ❑lkm mi ❑OWa ❑Rgmdug l Awdasmr nate <br /> PEOP8rA InEWled Ik aDo. wimW-Cano ❑LRhm <br /> O Co.ere1s Pd dW Dls of - Width_ n L R Thick i. OCIRrWyllm, 1381st. <br /> PUMP 13Subm..rb ❑Turbine ❑dim__ HP_ "Sm—ft 91.6"Wo Lcmi R Q <br /> TY®,I.DYRM.TrfIN ❑Opm Bamm ❑(bn•d P&.k ❑Unmmd ❑Orh. <br /> Wdl Dlstnemr i. Twl Depth ft D.p1h W W.Im ft ❑Cdgg.be PerRXXbd Rmp_ft m ft <br /> EISA{URMW ❑Neat Cemml(W fb dog/Y10 SW ) 09rod Ccamt aadah/7 pt war 13 Sm rdm Pell= <br /> ❑Bealaoim aG%.Iidx) ❑M.vuf.Wtm Sp.%Wi s_--% Kl ❑Sp¢a w Fik ❑Spec SubtetUd <br /> PI momw ❑PmnpM ❑Free Fail ❑other <br /> ❑ComPlm vim Muabtoom OW R belay&.dr ❑Complete m aiming SurMw Ped <br /> I MR6BY CERTIFY THAT I HAVE PREPARED THIS APPLICATIO14 AND THAT T=WORK W W.BE HONE IN ACCORDANCE%Tm SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAVW%AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE N9TH THE CA4PORMA CONfRACRiRS STATE LICENSE WARD AND TRAT I AM IN COMPLIANCE WITH AIL <br /> WORKERS COMPENSATION LAWS <br /> N UM 24 OU ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TRLE Y DATB <br /> re <br /> aq <br /> r _ <br /> wq0 <br /> DEPARTMENT Y <br /> AppTitation Amcpled q Dam N A�� PnWToyct TOg O U f <br /> Drout InryaSicn By ❑ SPECIAL-Well Permit <br /> Pump lvR.cuo.By Dam ❑ WAIVER Reeelved <br /> Dw.uc@m Ivgseuoo By Dsm C..dreeted Wen Depth _n. <br /> COMMENTS 4 <br /> c.a�-I.e crew Slc L c/d-/rS <br /> _ Oslo I.fs XN Retitled Dass Ssrvb . I.wlntl •r•n IDP <br /> +3_0t to 67 6fo-1 — I O U a a,Lo K <br /> EHD4IV2•Do6Q <br /> ILY700P Sd / � MRWATEXWIR <br /> Alcglp(cY /. � A2 � +fid n �Lwh— "C;7 <br /> 4 t 69 <br />