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WELL / PUMP PERMIT <br /> F==tsvcto OUM COUKn DMRC"tA NTAL HEani DUARTMCn 30 E WrBZR AVx 3'10 FL-STOCKTCN CA M02 (209)4442 lf- <br /> IY NRE<~vNDAiaLEPFRMIT CALL 2(Y) 943-7697 FOR INSE']eCTION'S F"HM I YEAR FROM DATE ISWFa <br /> :;_70( 6-7 T• Li ,) ib r,:; 40 � <br /> ifyKADDRM 1� 'h Wrs 4 (o r- Un; �rc�l` r;+•c C 2tr r cert 8533 <br /> er <br /> se <br /> CEOW&TRM _PARCELSI= W71AKDUs9ArmcAnomN <br /> ar&= i 1 4 - <br /> 312-1 <br /> ADDK= 113Z Aloprne.. - Cir ISrAti 8f1.[F M r C �' / <br /> i <br /> ti <br /> CONTRACTOR Ryzt t,- e__ FROM Yoe?.- 'IQ 910 <br /> Ct7Ptt AACTOR AlitLa= Ll ro. CC7YIS7a►i1CfLCP M <br /> i <br /> SU># UYrRAtr 0X TLola. PEt01MB - l OZ �` <br /> Sl1tfCOt+riRAL7ORADDRLn 2-966 .' 1r�1f1S7'A LTI•�l�l'r "c� Cal.'lro�A ?�i/5.3�i!, <br /> Licum M�C-57 O Obi O D-09 O Otbu PIPMATIOH DArIC 12— 3 i� 0 <br /> GEMRAPHICALINFORt AI-JON: Coordinates )C �I2.f 2 Y 3 Township Rasrge Swim- <br /> PUMIMUsy Q Dornatic4)&ate Q IrrigatiaNAgrian40=1 l)I AmkW d Wita Quality Monitoring 13.361 SamplirtWCharactmizziion �1- <br /> O public.Water Systan <br /> I f dffmwrl N=Ownw, watgr kyzt=Ncm urtia as <br /> arEOrwon []New well G Replamna d wea O well AyteexliaWbSodif cation 13 Other _ <br /> f]hWiuwryng Wdl(s) 0 orwats B�Soil Sorialgo) ad�b0f" G G ec2tnu [_ 4j +011*1V"+ <br /> 0 D i"-Seryrd <br /> ice Well Q O -Of Sayscc Wall P.MCWal Q Cfo"-Cortnoctian Repair <br /> ]New Pomp O Pam R Iacemer! Q pump Repair c 1 o-; n x <br /> ` Drilling Method Q Mad Rotary G AirRcrtz2y t8/Amgw 13 Cahk Toni a pub P06A O ckhff <br /> Propase+d Welt Depth, fl Excavation is diarneta Q Opal I90ttDm O G=Vcl Pack 1 Gravel Stu in 4 is:sseiar C <br /> Q C00404w Casiog in diatactar f Conductor Laing Dcpih ft �- <br /> Well Casing Diametrx- _ in Thidknar/G�AUgdA.STM Sebod Q Simi O Plastic cl Sisinleas Steell 0 Other <br /> Grant Seal Depth tl ONaat Ccmcnt(W lb&U15.10&t awj Q Surd Ce'mmt - -- awk Helix!7 gni wma <br /> D Bantcfnite(20%801141) Q mXm5awax Spec%aPlsda % Namn q Sport+cm File Cl Spens Suba dttod <br /> Grout Placrmca1 Method Q Reaped Q Frvc Fail Q Ottrcr Q Rcaardarr[ Aacoknlar(fume) <br /> Ptnnr+� Iruallled By 13 Chiller Q Pump Contractor O Other <br /> 13Concretr F4destal Dimensions:Width-ft ftTb1ck in 00TBox UStaivePipe <br /> tl>vIP Q Suk=zibk Q Tuibina Q tuber Set ft S Water Lavie! i p <br /> I HERMY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT Till: WORK WILL BE DONE IN ACCORDANCE WMI SAN � <br /> JOAQUIN COUNTY ORDINANC A STATE LAWS. AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY RXQQEJIR>'.D I.ICFNSI.' IS <br /> CURRENT AND ACTIVE WITH ME CALIFORNIA CONTRACTORS STATE LICENSE: BOARD AND THAT i AM IN COMPLCANc WITH ALL-; _ <br />