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1 II 1 <br /> 1- I' 1 ••' • • 1 I' I <br /> I' VAi 1 <br /> X, l l G PHONE C-57 LICENSE#-3--/— —EXP DATE 6— L <br /> / <br /> GE,IGRAifMCAL IqFkAMATION: COORDINATES X-- Y TOWNSHIP— RANGE SECTION <br /> TYPE OF V&LL;>it NEW WELL 0 REPLACEMENT WELL 0 MONITORING WELL# R <br /> INSTALLATION: 0 WEILSYSTFM REPAIR 13 CROSS-CONNECT REPAIR OVAPOR <br /> ATER LEVEL <br /> � • <br /> 13 OUT-OP-SERVICE WELL 0 GEOTEC"NICAL# 0 SOIL BORING IC71ON: <br /> INTENDED TYPE OF CONSTRUCTION SPECIFICATIO <br /> 0 INDUSTRIAL 0 OPEN BOTTOM WELL EXCAVATION DL4,—L!=— CONDUCTOR CASING DIA— <br /> ■ ■ DRIVEN • DEPTHSPECIFICATION <br /> ■ IRRIGATION/AG <br /> • MONITORING GROUTr ONO <br /> ■ CHRISTY BOX ■ STOVE PIPE CONCRETE • DRILLER: ONO <br /> APPROXIMATE WDEPTH <br /> PROPOSED • • r' I1 •• • • AIR • OTHERf� <br /> HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION1 THAT THE1 ' I DONE INACCORDANCE <br /> JOAQUIN COUNTYORDINANCES,l 1 RULES AND REGULATIONS. I ALSO CERTIFY <br /> 1 ACTIVE WITH THECALIFORNIA1 1 ' BOARD AND THAT I AM IN COMPLIANCEWORKMAN'S <br /> COMPENSATION <br /> MINIMUM 24 HOUR ADVANCE • • FOR INSPECTIONS <br /> i <br /> SHINE <br /> • ar � L ----TM.EC r . • <br /> !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! <br /> i!!!!!!!!�■!!!!1■Ci!!!!■A!!!!!!!!!■1!!AI_Il1.111I�h:aFl2Jli <br /> i!!!!!!!!■■!!!!1■!!!!!■�!!!!!!I!�I!■IEj:►lCF3!ti•.lf1A■IWAt�'i! <br /> !!!0!!!!!■■llA7L�a1!\��llA_1711■N!!Ci!!i!■■\■�!!!!!i! <br /> i!!!!!!!!■■tl17R1!!!!!t�'I!1■!!!!a!�:i11■■l'rJi!!!!!! <br /> i!!i!!!!!■tA!■:a�liRiill■!!!!V!!!!1■E'.i!!!!!!! <br /> iwil�iN!!■■IS!�7L��lR7l.!!!I■!!!!r�!!!!I■Q17ti!!!!!!! <br /> !!!!!!!!!1■!!!moi!!!!■I!!!!!!!!!!ir!!!!!i!! <br /> IDEPARTMENT ONLY <br /> Application Accepted Dat . r.. <br /> Gtnut Inspection By r, r. <br /> Destruction Inspection By Date <br /> REMITTED <br /> ym �m0_��' �' ' <br />