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,y Sell '°N Wd :E 9101 Zl ' nV a1u11 penia°a <br /> WELUPUMP PERMIT <br /> SO;JoaquarCouNTTENvtecNe+vaTPL1� TNDU%An,JNT 18MEa9TH—TONAV"UE.STOCKIOHCA95205_(203)463.5410 <br /> MON-REFUNDABLE PERWT CALL 209 953-7697 FOR WSPECTlONS EXPIRES Z YEAR FRom DATE IssLwD <br /> 0 <br /> JDB ADDR-sss cmimp L i n d e <br /> Ca 95236 <br /> CRosS STR£'T �T TIl �• R(j APN PARCF_S¢e _A?0 Lh E APPCICA=ra R 1 0 <br /> CwNERNnatE C&A 1.Aszmmnrci3O P.curz209-629-1204 m <br /> OWNER ADDRESS CnYdSTA'twlae <br /> CONTRA=OR Purviance -Drillers, Inc. PKC 209-887-3554 <br /> COAMACTCn AcoizEm P. O. ?3QX 64 CmJSTA'SdZID Ilinden, CA 9523 <br /> SUHCZWTRA 70R PHONE <br /> SU8CoNMACTOR AocRms CRYlSTa7EIZtp i <br /> UcEmg :,CS7 L C-61 D-09 v Other NiR,raEA 377923 E WAIATION DATE 7131 /L7 <br /> GEOatnKAULINFOPMA-ScN_ Coordinates X Y Tow6sblp_ Range Section_ <br /> IHIFlaDEGUSa t10e7telft- bate C hi-. V=VAgrkuAural L'tndustral _WaSerOuaiIdorolorn6 M So3 SampGn2fChraCe_'tra%,n <br /> I.-futftA'aler <br /> Ia:rrv2 Coat Qweee A•r:. aax ..cnm •,1,•if • amv <br /> TYPE OF WORE _Ka,Wr_! L R"cemmnt Nail J VJWIAl*ratic ft&d34carion L Other <br /> t4crA0619VWtr) ZdWails fl SailBadvII(s) sertsdraa -Geatednlcal aOrporg <br /> Out�YSe+viw Wed Cut-OfSevica Y'Jr'i Rrnev+al r'.Crass-Ccnmevan Rep.ar i <br /> ' a N_N Pumo L Pum Reslacemeat C Parra xr 1.P.a:-W_II Crain <br /> V/ELL CG-iRRUCi1G� <br /> CrillIng Method .1Jud Rotay •_Ai Rotary• -'Anger L CatleTcal ;Push Pant Other <br /> Proposed We'I Depth R E.Sca-rr_ In diameter Open Eohcm G Gravel PeddGravei Sae In'J•ranlelM <br /> ' ,,Con�uCorCastng indianl�er / Cotdura-CiLingQepth ft <br /> j WaU Casing Diameter in Tltidma.WGaaWASTM S:hed Steal ! ?lastie C Stanfes;Steel O Othzr <br /> t Grout SeRl 481`th R J Neat Cenent(941b b3�510ga/:tareo O Sand Cenentsardr rr�tn yep wmer <br /> ;Benlanite(X--sada) ',Other <br /> LGrautPlacement-Mathod G PLIpped C Free Fad ^Other Ci Retardant/Acceteralor(a-mw) <br /> ' PEDErra_ Installed By C Ih4ier 'Pimp CmLacaT C Giber <br /> COnueto Padestd_Dimenslons_Wdth R LengQt P Twck In t;Christy Boa Slaw Wpa <br /> PUMP 4 Subme blcu Turbine a Other mp CL Pump Se tt SlancEM�Xa'er Level R <br /> I HEREBY CERTIFY THAT I NAVE PRFI�IARcD THIS APPLICATION AND THAT THE WORK WILL BE CONE IM ACCORDANCE WR}t SAN <br /> JOAQUIN COUNTY ORDINANCE$ STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIF(THAT MY RECUIRFD UCF,. 1S <br /> C!JRREivT At'rJ ACTIVE WVITH THE CALIFORNIA CONTRACTORS STATE LICENSE EOARD AND THAT f AM IN COMPLIANCE YtrrR ALL <br /> LVORKE PtIVSATTONLAVJS <br /> [;71NI S 24 H <br /> �RCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)9P 7697 <br /> sICIIEn Corporate Secretes (e,, _({o <br /> I I <br /> t - - <br /> f { ! I <br /> ! ! I I I I <br /> IF I I t <br /> AA llt 10 NEL) <br /> I f li If iI <br /> I ! i <br /> PAYME I ! — 2016 <br /> RETE ! I I , <br /> nit I <br /> AL HFJ`.LTE f <br /> HUl7 2 I I I I I ! I ► Irl^.-rnnrrg <br /> E,ppilOs Eta _ 1 <br /> uEp,LTY 01 <br /> I ! I <br /> t <br /> P aTMENT UE O LY <br /> App",•alionAccepld Mp Cale I Z3 <br /> �� <br /> Gmut Imed;Dn% Date D SPECIAL Well Permit <br /> Pi,nplrsnec:ion9y Date 7 WAIVERR?CEiVed <br /> SoE S Inspection BY. Date Constructed Vlell Q=plh__ ft <br /> COCOMMENTSNTNT5 <br /> PE SC Racelved ChecW IAmou-n-t-T Data ➢ermW <br /> Codes Info B Cash ! Iemhteri SorvlrrRegvestC ' Invaprz# ( 4Va1311 <br /> T61,010 icy SRUo�sS� W 00 qU <br /> anrirz wFs,L vur,a veew <br /> E'd bL5£L8860Z OUI s.lspuQ eoUl:lnlnd d90:I.L Z0 ZZ isgV <br />