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WELL/PUMP PERMIT <br /> SAN JOAQUIH COIINII"ENVIRONMLNfALNGLT9 DLPAlTMar 301E W6n[RAVE garf-SrOOITOM CA 98283-(2m)JdB-Y/=B <br /> NON-REFUNDABLE PERMIT CALL 209 9SJ-7697 FOR INSPECTIONS EXPIRES 1 YBAR PROM DATE ISSUED <br /> .5 1 <br /> JOSADDR P /��dt- 333a pJ `1IS'V �"�•'M�',yL.M, <br /> LA APN > A:_ "NDB[ <br /> Coast AP/n,.IUT//S <br /> 0ANERNAMB PRONE <br /> OWER ADDRESSG C ISTATLaAr 5jlfj � <br /> 1 <br /> l� <br /> fJ a <br /> PRONE <br /> coNtwcroR I h <br /> CITYISPATZZIP <br /> CONIRACIOR ADDRiAE /J/_��j -S—l2 <br /> 1 _ .11 A," C^ <br /> PRONE -LSI J -1 <br /> SuacoHrGC80R Lf'XA I ! - <br /> C1T'/$TAT[/7.IT I/1]A• E••� <br /> suacoNlwACTOB ADDREss <br /> LKeNse O G57 ❑C-61 ❑DlN O Utber <br /> rvURBER ExnunoH DATE <br /> GEOCGTmf lNe MA"ON: CDr -W % <br /> Y Trreuhip_ RvvBe__ Serrano_ <br /> Nv[ OET 13Dornenic/Privete ❑IrrigrtiWApicWhwl ❑I1 anu.l ❑Water Quuliry Moitorine 13 Sail SamDling/Charxurinoo <br /> ❑Public Wercr Syelem r� nun ercx <br /> V d,Dumr from M+r <br /> T Oe Won ❑Net,Well ❑Repleccmrnt Well ❑Wdl AlmntioNModiftudo eetborn, ernrrhr <br /> M of.1h ❑Soil Baring(.)— ❑Ouarhniul__ <br /> [3 Moniaring Well(r)_ <br /> ❑Out-0fServiu Well ❑Dart-0f-Service Well Rmewel ❑CrouConrmcdon Repir <br /> 111_New Pum ❑Pum Reploxener, ❑Pum Repow <br /> W <br /> Drilling Method [3 Mud Rotary ❑Air Rotary ❑Au," ❑Cabk Tool 13 Ruth Point ❑OUtt W <br /> Propored Well Depth ft ExuVBDOn ih diameter ❑UP.Boom ❑Gravel Pack/Gnvel Sue_iat dirmeur -� <br /> ❑Conductor Cuing <br /> in dirmete, / COnducur Cuing Uti th ft N <br /> n Thickrim✓GruB�ASTM&bed ❑Sarl ❑Snout <br /> ❑Suinluc Sar- ❑fBber <br /> Well CBdvg Diemear_i ❑SnM Cement sack mu 17 gel carter <br /> Grout Send 0 Seekonk, <br /> R ❑Nur Cement(pl lb Dog luh Sal carer) ❑g a on File ❑Spec.Submi9ed <br /> ❑BumWu(20K soFd.) ❑Manufrcattt Spar°/.eolid.__Y. Name <br /> Grout PecerrRvt McWod ❑Purrlpod <br /> ❑Fra Fall ❑Other ❑RelaWnnt/Auelnatm(risme) <br /> T.EP.F�L IuuBN BY ❑Dnlltt ❑PumD Conacur ❑ Other ftThick in ❑ChAdy Boa ❑SUNB MP. <br /> ❑Concrete PederW Dimevriou:WMlb__ft Lev <br /> Subrnmibk ❑Tutbiu ❑Odw <br /> HP Pump Set ft Suading WRer Level ft <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQCURRUUIIN COUNTY OREIWITJCES,H THE CALIFORNIA CONTRACTORS SAND RULES AND TATE LICENSE BOARD AND THAT AM N COMGULATIONS. I ALSO CERTIFY THAT MY P IANCELWITH ALL <br /> T <br /> WORKERS COMPENSATION LAWS <br /> MI MUM 24 HOUR ADVANCE NOTICE REOPRED FSR INSPECTIONS <br /> ��/0,. J,..:. R.T.. <br /> s1aNe0_ i � <br /> va <br /> a <br /> It <br /> $ AYMEP <br /> Al,Pf T RECEIVI <br /> Q � g <br /> i ; e: ? k4 AUG 1 0 ; <br /> Ea iia r is 94 ys -E tl <br /> F1. itSA <br /> 5d gS N JOAOUINI <br /> Sgg ENVIRONME <br /> i t �� it HEALTH DEPAHI Nv R. <br /> 1 <br /> E � 2c o <br /> - =as 3N01 N�dr dw»s <br /> jt,ta <br /> ate g I o G� Arra Btnpbyu I <br /> DrDon, DN <br /> Application,Application,Acceprd By ❑ SPECIAL Well Permit <br /> Grout lnrystion By ❑ WAIVER Received <br /> Dnu <br /> Pump Inspatio <br /> R <br /> Canuruud Well Depth -5-1 WEIr- ML <br /> 6F <br /> COMMENTS SF GoAJOe U'J °C R- <br /> n✓ A " I <br /> Butternut Cyr Anauvt Deu lermlD Ivvnke9 Well HIS <br /> R Sc nah Be <br /> Servlu Sate <br /> Cvdu lot. B <br /> W clso --s- 00 Sp.r4 10 <br /> weJ.nAvruMrr <br /> rmnoR <br />