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WELUPUMP PERMIT 1 ✓ <br /> SAN JnAGI IN C(hINTY ErvtVCNNEkTAL HEALTH DEPARTMEVr I E.irr HA2ELT0N AVE\JE-STXKTOr.CA 9.5205,-IVA'-46&3420 <br /> NON-REFUNDABLE PERMIT tALL 209)953-7697 OR INSPECTIONS EXPIRES 1 YEAR FRM DATE ISSUED <br /> i/ 7�fj C/ <br /> JOV ADUNLsa 1•�J 1.. e o GT'!ZP''PCo , (.0 D <br /> CROSS 5-,RE--T_ V lvr AP ., PARGFt SVr LAND USE APPLICATION n 0 <br /> _- _ m <br /> P yY' a <br /> OTrMEF NAME / ■■nn�, '' /.�.X51.PryTLUNr J) _ <br /> Om,Ek AU(AESS "_V C-TIV- A 'L1 PTOO k' <br /> CosrRAcroH P u1 � <br /> Cosf1tac,oR ADO U ! N �J -- _ C TYf$TA•EL Piny •{/ — <br /> Sljoco TeACiGa f vl __. _- P E <br /> SumixATRACTOR ADDREU t l <br /> LICENSE G-57 -61 nOa O,R•ULI NUMBER Q EXPIRATION DATE l T <br /> GEOGRAPHICAL�INTr91Rit11rtDM: Coordinates X Y Towmship_- Rmrge Sacdon_ <br /> 1KTFNDrD Usr Y D-masecPdvaN_ Inigatim,AgrcitDural InoJ5try1 t'+atpr C*Ia!uy 6A:ntunrq SO:SBmDDmp'G'tararmrzeTwr <br /> w <br /> PJDIb Plate'Systan r+� <br /> rerh m'nen om R' t . — - ;_3 lx <br /> - <br /> TYPE OF WIAK New'Well NRDIafArre."t'Not �-'!yell ANero-ar.lhd?'zeucn Oder <br /> s ceDTngi r,.r a•R;e <br /> M:rbn,^,'+1'Nhs; act vAprb Still Bonngsl .-;arnrrim_al <br /> Ot-OI-SevEtl OkA-Of•Se•vice Well Rerewal (;rpssCmna:•ticn Rel:a: ---- <br /> New Pint Purtp Repwarnent PumpR22 11_ _ Raise Well Cnanj _ Q.WELL CONSTR'JCIXM <br /> DrNFng Method VLd Ratan At Ratar, AiMr CM19 Ion, Pt:sh Pont Dlher <br /> 'Prpoosed Well DeDtn P EALISVShOn n oemete` Open Bodum Graval Pack Grave Size_ -+'' TIZ. <br /> Conclumor CRsdV tr dtamrler ! Cmcu_lor Ceslrq Oar" 4 <br /> Well Casing Dwre!e' __M Thdcnsas Gauga+ASTM Sc ned_J_ St" Plash Stairlems-tee, Oitwr U <br /> Grout Sea! Dep^•+ R Nee"C:emwV 194 at Aaat 70 ga'•wo!er, Sand Cement sack rnw•.17 gal Ovate, C, <br /> BRMonea 120%saldsl Otter <br /> Grout Placement Megsed PuMPed Free F811 Otter F(?ra'!1arr.:A.-=Ierat!a InBrne;_ f _ <br /> PrGE9f iAL InsLillO By Df!ler Rump Co,tractot Cmer <br /> i _ Iuterele PerMW ubmnsloas 1Y'Q,0_11 L.erv,--. _ _ ^-nr.. m Chrlsty Boz Stove Pipe <br /> IP_jlp Su:mmiNe T•urDift frE'.-- HP - r.ITp�t.> 5�rdnClVx,MLevel_ <br /> I HEREBY CERTIFY 1HAT I HAVE PREPARED THIS APPLJCATION AND THAT THE WORN WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS -ZN <br /> CURRENt AND ACTIVE W THE CALIFORNIA CONTRACTORS STATE I ICFNSE BOARD AND THAT I AN IN COMPLIANCE WITH ALL <br /> WORtaPFNSA LAWS. <br /> C~ I LIUM 24 O R ADVA NOTICE.-REQUIRED FMIIN}SPP]EC/T/�IONS�PLEASE CALL(209)9 3.76 <br /> TLE2 r r L (-C/I L�.1. - <br /> - Ric Oft <br /> 'Aft <br /> I ��FNT <br /> V� CiE r <br /> AN 29 <br /> �' 'Cfi�dFF;'AL y <br /> - ft/SERV,ICETH <br /> DE PARTM E 18E ONLY <br /> ' <br /> ADDIO-Rbon Accepted ev � f!alc // t1 Area ' _rnt�rrr IDA_-) r <br /> Gtcu:Insoed�0+'8y _ Oa�'2� _ SPECIAL WBII Perrnit <br /> Remo Inspector By V •11 WAIVER Received <br /> Sal Bump I nsDen nn BY Oa:e Constructed WeR NPtO R <br /> COMMENTS - — — <br /> PE SC Received Amourtt Data Permit' I invo_e M I WelllUR <br /> GOdee W. <br /> ash Remitted Service RegneDt a <br /> y3r1 OSS .,? -7 7 ' S wPoo37G7l <br />