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a <br /> WELL/PUMP PERMIT <br /> $AHJOAQNN COUNTY ENVIRONMENTAL HBALTR DIPART.NBNI' Q110 E.main Strait-STO[K1tlN CA 9520E-(109)46g-I420 <br /> NON-REFUNDABL <br /> E <br /> PERMIIT CALL 209 953-7697 FOR 1111m.molls EXPIRES I YEAR FROM DIATE ISSUED <br /> Joe ADoansl ( 1�.7 7 o Sr Ke�su ro� �/ys. a—v((�� <br /> GRms61¢eer IU llv APN Av I03W3 pAneeL SReyLL,j_LAnD Use.VrucsnDNp <br /> Y1S <br /> owneR NAME Shea- MOUn ales No�. CC PHONE <br /> ONNERADDRE9e COWATATe/EIP IJ <br /> CONTYALTDR S� C . P�MN� A —ViII <br /> COMM RADDR s 13' CHY/STATR7" ON <br /> Li z'l W qg3go <br /> SURCQNTRACTOR B1,���� ynn/PRIX11 � 0101 <br /> S%HNC() R RAODRtsv s Ia1 k /hY�+ �_ CTMISTAn/EtE11 K1 J JI(J <br /> Lrczvst 6-57 ❑CAI ❑D-09 ❑Otherr Nsm mut 1 ExetRAnDN DATe <br /> CRoeRAeRtULInPoRMAnon: Coordinates X Y - TE.Ehlp Range_ Seal._ <br /> 7NrzNDEDUSE ❑Domeatic/Private Cl IrdiNtioNAgricultuml 13 Industrial ❑Witter Quality Monitoring uil Sarrgling/Characmrication <br /> ❑Public Water System <br /> .w Symom .m. .er ... u <br /> TYPEOFWOEtc Now Wali ❑Replacement Well ❑Well Altcntion/ModlfiaYoo OOther <br /> ❑Monitoring Well(s)_eofwellr SoBBoringD) -a.re.ndrr Gcmeobni a a' T <br /> ❑Out-Omervice Well ❑❑Out-0f--Savior Well Renew.] ❑C..Cormadonparr <br /> D NEW Purrip Cl Purno,Replacement ❑Purnit,Repair <br /> WELLCQNsmincr ni CPT Drilling Method XMW Rat-), ❑rrsAtyylr\Rotary O(Au A ❑Cable Tool ❑Push Paint YONer C f I •O� <br /> Proposed Well Depth�.0 Excavation�in di.wr ❑Open Bottom ❑GNO.1 Pack 10.1 Sire in diwmer e; 1 <br /> ClConducmr Cuing di.ecar / Conductor Caring Depth R rsv <br /> Well Cuing Diamekr in Thi. ug a TM Scbed ❑Steel ❑Plastic ❑Swine.Steel 0 Off. Y'-- <br /> Grout Seat Depth R IJeu C ent ry4/b bsg/J-10gal wnler) O Sand Carron Bock m&/7 gal water <br /> Brntooik REV=,, <br /> ❑ turner Spec%solids_% Name ❑Spots on File ❑Specs Submitted <br /> Crout Placement Method Pumped Free Fall Clother ❑Ratatdam/Accelerator(rums) <br /> PeoenAy Inatalled By C3Drillcr ❑Pump Contractor Cl Other <br /> ClCoecrate Pedestal Dlmendam:WldM_O Lmgth RThick N ❑ChristyBox ❑Stove Plpe <br /> PUMe ❑Submersible ❑Turbine. ❑Other HP _ Pump Set RStanding Water Level R <br /> t HEREBY CERTIFY THAT I 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 15 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> - <br /> WORKERS C ENSAIVP LAWS. <br /> QX�INIMUM 24 HOUR ADVANCE NOTICF EQUI D 1I�'Q_R INSPE f:PIONS <br /> S1crIEo i..— V• rG 1Y�/Y�Ab.I DAn <br /> PAYMENT <br /> RECEIVED <br /> JUL 13 2007 <br /> • - LN JOAQUIN COUNI <br /> ENVIRONMENTAL <br /> EALTH DEPARTMEN- <br /> I LIN <br /> PARTMENT /USE O LV r/ <br /> Application Acecpt Da 1 Area Employ rDN f�///q� <br /> Grout Inspection By Dale ❑ SPECIAL WeR Permit <br /> Pump Inspection By to ❑ WAIVERReceived <br /> Construeted Well Ikpdx R �r <br /> - COMMENTS -I'D spnat- GL'InP./2—fN.f_, <br /> PE SC Rited ed Chetld/ Amount DatePareait/ Invokes Well ID# <br /> Codes �lor. B Cub Remitted 'oeR u.A# <br /> ,v <br /> 1 <br /> Pxoamam.en /lin ��IL�YV�.- .ba- (p �I ��� weu.ru.0 rsrNO <br /> Imnom l J <br />