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WELL/PUMP PERMIT <br /> SAII JDAQQt: C0VIfrY&VIPWILIVITAL fl_At:fll OUT #154191 1866 EVE-,Httsl[oil Aygaluo--5-m"rcri!'�A N52-)9,0232- <br /> NON-RCFUNDABLE PEP?AIT CALL(200)053,7601 fQfl INSPECTIOH8 EXPIRES 1 Yf':AP PRO-1v1 DAT I!ISUUED <br /> JOB k)DRu1:$ /19138 El. Highway 12 - ells LN-L Qdj <br /> 0�5-160-66 _FtPV;tL SIZE LAND USE APPLICATOU <br /> 0WHER NA-E p'a <br /> OWNERAI)DAEGS <br /> couTpAcyok Delg 209-466-9625 <br /> Cc,ffTkA0TORArjDfIUt 646 S. California Street__ _ CITY1STATf/Z(P,..._-Stockton, CA 95203 <br /> yUOCOWM4CTOk __ --- PlioNe <br /> 3VI)MURAIA01%ADMM <br /> L4^M59 D C-67 N C-61 00-09 0 othar NG-moFR--ZIILZ-Z8 15XPJRATJ0tfJ)4YE <br /> GEOekr�nICMINFORMATION: C00I*dh0(6z X Y. Tawn:hIp_ Rangc_ Scollon— <br /> i,n EA,OPI,ijkri It 0onj6hUdrjjv8(* 0 1,rig i I10rVA0rfi;(,1jwqI U lnftSjdl 0 Wn(xlr Quelily Morl(winq C Boll 8amp11rjChajac1@AzaUon <br /> D Public Walor&'tefn <br /> f4anm <br /> TYPE OF Wor, o Now WsU 0 Fbep[666,'hbht W611 0%;*1[/Wotdory?,lodificFalon 0 OLher <br /> (I h1urillodw 0 cirwoll$ 0 0;4wngl 0 C;,3o!t3rhrkIc-3l tiorw`q' <br /> 0 0Ul-Of-86rAC6 W611 0 Out-Or-Sery1w W611 A6,).v9' 0 Cmconnecuol)nopilf <br /> G New Pum ., 0 Pijfnl)R8pffiC*jr0rI 0 Pump RqpsIr —.-13 Rall.Wall ca-1. P.-ki-9e- PLITOT), inst€r 1 <br /> Lid Ro(ory 0 Air Roiary, D Auger 0 Celilo Tool D Pvth POW 0 OLhof_ <br /> Propo5od WOt DopLh_.ft exr.6vnual—In 41ornolor 0 Open BoLlom 0 Gravel Fa,.k1Grsv61 Slzu h diarnolur <br /> 0Condut1bfC;i1;hiq_In0tnmotef I Conductor Casing Dcipth I <br /> W05 CmIng OlarAtter—In ThIckrb,-afc33uqe1Al3TIA Sched_ 13 fl--1 I)Ph,;Go 0 qtnIrfj*r-Sloel cl O(hor <br /> Grout 90-1 bspvn—ft 0 Neat Corriont(04 Ib ba-g16'-10 go]watGo 0 SE")d culoved —,wA rplxrl gal wwor <br /> 0 Br.njonjtn(2D'jj srjl!da) 0 01ti6e <br /> GrQp(PlaCorlioni-Meithod 0 Pumped o Ffo6 rem .0 Mar 0 Rti!ardant/Ace.elfiiatirjnai)iB)_ <br /> FpEvEsul InStpnod By 0 Driller 0 Pump Contractor C, 0(her <br /> ConCro(o Pedo0s;Dinionslons Widn.p Length • Box Q <br /> [J.O(hor. It SicndLno Waler Levol 77 h <br /> I HEREBY CERTIFY THAT I HAVE PREPARED TH13 APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE VJrrH SAN <br /> JOAQUIN COUNTY ORDNANCE$, STATE LAWS, AND RULES AND RF(3U1,ATI0N$. I ALSO CEFZTIFY THAT MY REQUIREb LICENSE' Is <br /> CLInR5NT AND AOTIV,s WITH THE CALIFORNIA CQ1,?TRACT0R$ $TATF LIGUNUE BOARD AND THAT.) AM It] COMPLIANCE W(TH ALL <br /> WORKERS COMPENSATLM s. <br /> MINI UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> DATE 06/211/13 <br /> TI FLO CrO <br /> A <br /> I IA I I - J I <br /> V17, h JA <br /> -A-T I.C L:-: <br /> (-I T <br /> DEPARTI'MENT USF 0h LY <br /> Appr—e.n Avcopled By 1p— Dale ;N13 poyoE.1cr <br /> Grout <br /> SPEGIALW911 Permit <br /> Pump <br /> WAIVE!R Received <br /> Soll 13Grl I Inspection R ...... Congieveled Well Depth A <br /> .,t) <br /> Sc <br /> Re1v*ctT �jk� 7 Amountnt Dito 'iQ�1-1 Li--- nwQ <br /> lico 0 Well ID# <br /> �101jRequav 0 <br /> ?-Z2-3 <br />