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MAY-16-2005(MON) 09;33 CGRS CALIFORNIA P.004/00a991 1177 P.00d/00 <br />J§ WZLL / PUMPPERMU 0 <br />�r.lpAquttv�buarl7�6M'�l -ALIO LMI AR%U �t1� JB412WcawAyl;3"tY.-3MCxw C&#=Uz-(N9)4Pe-3= <br />QM2 FM'DAALEP CALL 09j 953-7647pnit I -la ¢c—MON5 E)MIRM 1 YEAlt FXCM IDaTR InCR IPA <br />E. VRE4kowT ST_y S OCfL 7 S' <br />SC <br />Info <br />asr�r+>;cr r t=. r�r 7-_, / 2 trn • d'' A=Ma= U (3 L= tt=APPI.2C4Tioa 0 <br />CChecW <br />ash <br />cNntnZ c A• U ryaxtq oh , 9t/f -- a yg <br />g <br />g` <br />�1►t+iRlllku�Rt;65 Z. tig �rz� r<u 0 �-7- S t-� CrrrrrsTA7Pl�il' d nr z Q 'S"' <br />.ss <br />3C --S77 <br />3 0D <br />� 0,i5—, <br />�A'�'� y ctirvrsrnmr�,r <br />aceN'CJL mn « <br />PttOiVlt <br />ECCMxAC=AMa40 CrrreTATlM?. <br />MMIM CI G37 Ct Cil d 7309 Dthcr NtJN it D %� � la+trtotf 3 <br />x14 rrgCAL7ilYiOR11t/LTlOr�1: Cggr Ale71 7l' Y Too+paltlp�` ICcagtt i _ Seca= <br />mm" 11M 1:1 DMarlPrF m 13 1alja0AWjoIIlwrnl C3Iaduatdcl D Wetari?urlity Mmtllaring 0 soil 6al>npliarlCJmrx�L�sdl�el <br />Q Patine Whlrr <br />(�dllsdoa T 0", <br />CAPS ar ae <br />r�Ot�wr�ue laNewwdff OReplaeq miWell 13wdtA1MM111gaMa02allaa Wolor offUNA[ <br />t0141aaitatiaP Wn71{C�,�a e8n�{Is b Stijl Botin,10) <br />dnrbatui ❑ 0winchniaa <br />I - <br />C G oOr-easviae wev ra oat.ScMcg wn1) Itr www 13 cmu caimewan RCPjj;r <br />l3Ncwy <br />cipluappmidewma r <br />RL � <br />191097Yl2lk0d C1MUfiMtara• i3AfrFzUry DAA,3, 1It7abt27b9a 07w,r0igt -Omar <br />mar.- <br />"M'Well UePth — it ?= Mdem / <br />..,,�.`�,,,4n dlamctrr La � 8vcfam D f3iatial x'sciclClail►a1Si:rx lx dimsicttr <br />D Conduelar CSS__.. is diameler I Ccndccmr `=ln$ pcptb ft <br />W94 a01109 13bft* 'Ch6M1o�*wwJAM <br />x_1z M .Srbcd O Saari D AMa4tie D 3Wn1=0 Skal 13 Other <br />1 <br />1 <br />G.aas&ml C"th -- � It D Sand Ce MML xrak arclp7slC3 <br />yMx <br />amma1M (20VO4alltll) C Ma ftdR uaSpce % aalids p=s File SPe=Sutau <br />aalPtsatmeaclKut3nd ONwaped t3rrerralt C10042r ©Remnlpnt/ll'Laalatahr ams] <br />a Re. lnaelBed$jr andlier ©PDRipCan0=j lr a* <br />v Caatratt r�ml Dlm�:lnn� Wtdtk Irt t'clltiok In G Cll • Dax D 6rarr piar <br />"E U 5kIbMwi3h, ©M,ehfrto C Other <br />-�—�. ...�� � res � snutal:u: �rLaeel It <br />c <br />Z <br />1 MkX CXRMY THAT I HAVR PREIrAR D THIS AMICAIIU N A" Tawr Tn WORK llt+lM 311 DONE ' <br />DI ACCa20 CC ITO .UN <br />AQ[W COUNTY DOMWIlIWCIM STATZ LA.W% A741D AULFE AJID UILIA77". I <br />AU6 CTM15-Y TNLT My lC qU=W UCRN3l; M <br />21MM APP ACME:nTx Till; CAI:I><iiGRM CONWACIMIN SrAn 110ENI; 11040AND TART Y AM <br />Eq COMPLIANT WITH ALL <br />3PIMMS LVMPVISA7' W LA. -11%&f <br />„ <br />n+mwaux 7A110URADVAN4�¢,'" XOTICE PXQTJMZD r, qXMqMCTj07jS <br />Isco acs a �ti� Irt D,�r>c S -1 Lo —oC <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Constructed Well Depth <br />COMMENTS <br />DEPARTMENT USE ONLY <br />Date `, �/ 7 �� Area <br />Date <br />Date <br />ft <br />Employee ID# -7 3/ <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />PE <br />Codes <br />SC <br />Info <br />Received <br />B <br />CChecW <br />ash <br />Amount Date <br />Remitted <br />Permit/Invoice # <br />Service Request # <br />Well ID# <br />.ss <br />3C --S77 <br />3 0D <br />� 0,i5—, <br />q3` d <br />EHD 43-02-006 <br />1/27/2005 WELL PUMP PERMIT <br />