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WELLIPUMP PERMIT <br /> SAH JnAcent COUM ENI RONEN7AL HEUTte DtPAWrMW law EAST HAMTON Avvex•STOCKTON CA 962W-(200)ASS-Un <br /> NON41EFUNDABU PERMIT CALL 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JosA IDr. <br /> CRAKesTtrEiT... Trj,,h,c'i.�a. Am 0 5--3C- <br /> Duatea Krum S . Si ' i A4-e-S P„Oi 9 1 <br /> O"INIMAatMMrJ' G73Yi3TATER S�C;Cit kGtti 5 G 4 <br /> CONTRACTOa \ACi r, 11 t n a -- PMI. c A 3 -a?`7.7g <br /> coNTrueTore Aonaysa��; . fi S[ �� CrTYI$tATttILP -� 1 C� 9�ro <br /> SUSCONTIRACTOR <br /> Pworet <br /> SUeoornrucToa Aocrtsa (X7Y157A7F/1>p <br /> Llet9+sEI C.V C.61 0 D09 u Other W 2yj Exact—OAT@ <br /> Domeii We.L SAy3h.8vo:❑Geseeral MinataUCOftem Bacti(4391)0 (4392)0 Arsenic(4393) <br /> PAM=USE 3 0 C C Water Owft Monaoe5t9 0 Scot S <br /> c Public Water System <br /> if daareM IM O0~ VAW&Jawexii CwMsetNs-4,Phow Nu bw <br /> TyM Of W WpS �New Web 0 Repiaoernett W eg 0 Wall 0 Other <br /> G MwAortrtp Wai!(s1__t Cf web C Sa(B*dno(s) s of bmvx c Geotechrkm O dtw hW <br /> e OW-01-SdrviceWdi 0 Chri OFSeaNu Well Renewal u mart Repair <br /> New i R D 0 Rahe vial Caaft <br /> OTWle9 M*dW d A Mud Rotary t C AY Rotary ❑Auger C Cable Tool '7 Punt Poira C Odd <br /> Proposed Woo D-p`h r 7 n Extavadon 2 0 dim c Open Baftm X Gravel PaduGravel Size )>4— ai damater <br /> eCawucwCa** indiw*W r Coi Caft Depth n <br /> wen Casi tYurmter m Ttad,,w*ggdASTN sdmd1� r,sud j�Nestle a Stabs Sees 0 mer <br /> Granasea( Depth ) n Nast Carrera M4 let LaprSlt)Oot weler) sand Cmnertt 1• i sarlc a*17 got,nater <br /> 0 Bentoift(20%ao9ds) 0 Outer <br /> Grout PLecamai Method Pumped c free Fal 0 other c RetaMara l Arsderator(Istria) <br /> Dow U PwM Cem - c Ottner <br /> �h+ radw <br /> p t7Dlmatai0m:uMaat n Leo R Thick in 0avisty,sox 0 stove Pipe <br /> IEM -A Submww*u TL&*m C Dow Pump R Stuetdirtg water Level11 <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAH <br /> JOAQUIN COUNTY ORDINANCES..STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CAL1FOt2WA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTION$-PLEASE CALL(209)953.7697 <br /> pr l' '; rSP 4- DATE <br /> c <br /> s �-- <br /> i <br /> 3 <br /> t �— <br /> t <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Daly Area empbyae Los <br /> Grout Inman BY Date 0 SPECLIL Well Permit <br /> Purty ktweci BY Data U WAVER Received <br /> Sad Balm By Date Conanicted Well Depth_ft <br /> COMMENTS <br /> PE SC gteG Arnotmt Date setvice oat3 WW.0 WenIDO <br /> Godes <br /> info Cash Remitted <br /> vrai mws rxwt <br /> END 4,106 retiastl tnILne <br />