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_ WELUPUMP PERMIT <br /> S"JoAmm CLldr m FNvYRtiNY1wAL HEALTn DEPARTMENT SW EAsT MAm ST*EET-$TocxToN CA 952172-(209)468.342 <br /> NON-REFUN0A8LE PERMIT r Lti r '�3��- &9?FTJ ti P#f TaC F+S _ E_ 112ES 9 YEAR FROM BATE ISSllEO �^ <br /> Job AW Ess � <br /> t"Jz <br /> oss S1"REET LAND USE APPLWATto rm z <br /> NAVE _p/s�p-�/A���� <br /> 1CONfRACTORt- <br /> 1 <br /> - -..,.. PHONE L.J�✓3'� J7!?!a!;7(.- <br /> COMRACTM Aomss V t. armSTAT51bP� C*. L.__ <br /> I'SUHCONTRAcroft PNS.... <br /> �$iiER:LtWRAG7OR ADONeas —_, C17Tf$7ATtr7CIP i <br /> rLfcENSE C-57 C 8t b09 other NUMBERnowo.. E»tAT1ONDATE� <br /> CEOGRApYHCAt 3rrf- N: Cacrrtpfates Jf_„ <br /> Y __...._.._.. _�I ..�..._.-..--..) <br /> —— —` Township_ R"o . SecUo:i__- <br /> 1 ED 138E ivate lmga iorVAgric.d al Industrial- Nater C3uafay Menitormg soil 5arr iingtCnaruccertzetiorr <br /> Water System <br /> ;imaaram eemr.Ornax — e t -tV FIVQN." <br /> Trp,£OF Wurtx Now Well Roplacuanrem Mde n W04 AN41-aAapR+Aadi7tc'ation Otter <br /> �+ 5. VMI(r) 4 0 wails Soo sorb41$ *ol I'ial"v6 '..—•-a [ReetlKlS <br /> �„� Ge0teC7WIiCa1 <br /> Out O4S V Out-Of-Semen Wa Renewal taos;-COrewemon Repair <br /> ew c taiemer3t Port Re�au �_ Rise We#casinr�.__-_.___ <br /> �W CONST .—. . <br /> 0-lWrg Methatt Rotary Air Rotary Na+w to TaW Push PwrN CiYtlar. <br /> ..,.,,„ <br /> .�rappsBrJ Vd6di :icp3-t `ti ....... xCavBYs:.n-_ `fiYYtrreYA'r„`.r�4'Y,®ir:E30tfvne Ur�ive#Par1rJ(}(gy '31YL'___... tn cLame[eri <br /> Ca doctor Carting ae aiamefer I Conductor Caslog Depth___.. N <br /> V3zSi Cxsmg Diameter_in TNc r esVGausraASTm sch d Stent mask Std SteW Other _ <br /> Gram Seaf DepiYe .K <br /> Neat Camattt;9c rb.bagt.+i-7a ga1 va -:) Sand-CcmcntsaCk mrx17 QW water <br /> Bsntaruie(n%SOWS) Oritrt___ <br /> 1 Grant Plactnmeart Myth- 6'-V- Free Fadi <br /> t�aTAt� instal��d8y,,`,,yDr�er Fhara42Con:radtrr Olhet <br /> CoycTeiePod %WOimensioos'vAWh N L —NThkk in CiftmtyBox 52aeaPgw '�r�s <br /> PUNa mrYs9.d mer _— IIP PLer42 Sef ,,,�„fd Stattdlttg 17dater LaArt—4. N._._I 4 d <br /> I HEREBY RTWY THAT VE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAI�i3iN C ANCES,STATE LAWS. ANA RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUMD LICENSE IS f <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> INIMUM 24 HOUR ADVANCE NO-ICE REQUIRED FOR INSPECTIONS <br /> SiONEo Ttrt FIt f <br /> — <br /> DATE � •�r <br /> `y5 <br /> 7 <br /> {N <br /> t �3 <br /> I I a 1 <br /> a j 1 <br /> 41 <br /> r 7 _ - <br /> $dry <br /> d C <br /> ENT <br /> 3 <br /> DEPARTMENT USf ONLY <br /> Apphoat bn Aw-pted Sy Date _�. Area Eo"oyee JOs <br /> Gut iets oo 5y. _... Ome_ SPECIAL Weil Permit J <br /> PLdv frapaclion BY, ---- Oete of,,... �✓' WAIVER Roceived <br /> Sod 80-01nsp Sy _ <br /> � _ Consiruttod Well Depth It <br /> COMMENTS �� __._ <br /> PE Raceivaf — ChrckW iirAaunt J Perm tJ <br /> Codas Into 8 Caste Rrmi4ted Date Srr.R.:. 4 WrN Ip1t <br /> ire vtb <br /> 1 7 <br /> WILL 9wll N.Akm i <br />