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HEYIINGS BROTHERS Fax 209-545-1729 Apr 30 2312 10:10am P001/001 <br /> YntLL1rurm1r vk--t i <br /> SAN JDAOUN COUNTY EN ARDNUENTAt WEALTH DEPARTMENT 600 EAST/RAIN STREET.STOrIII 95207 -1209)467-3420 <br /> NON•REFUNDAELE PERMIT CALL r209)953-7697 FOA;NSFE CIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> �3o0 �.�� Rpt. y1 <br /> IIJ09 ADDRE66 /�.E /'� ` C1rYl7)D 1 ` �cy Soy J <br /> CRcaeSTrr[r,r Q��rAkJ gpN1z,L.�3 -y�J��,PARCEL 9SE 111 if <br /> LAND USeAreuCAnON0 <br /> OWr1ER HANE t��9�M-01�s <br /> lPMOhECANNER ADDREae CT'ISTA TTJLI�\V Cr1YW�CC� .C�Q�I�SSI <br /> COATRAC:DR <br /> CONTRAC'OR ADDRE Sn 3cs G C.—STATEJLI <br /> suacoM c oA PHONE <br /> 8UFW0.".-uar AolI._ GTr,STATFJiIv �1 <br /> LICENSE ,5, Cel D-U9 011ier NUNSEA EXPAAYONDATE <br /> iaqta <br /> GEOCRAPIEIcAI INiORaAroN Coordtne!n X Y Township_ Rama_ Sac Non_ <br /> Wrt,OED USE DOmeslc/Pnvale tV9Q1ONA r!CulWrel L Indu sial Water OUahly Monllonng Sal$amp cngrCharaaarqadcn <br /> _Pucllc WeWr Syalem <br /> I <br /> I <br /> TYPE OF WOR.( w Wal Repleccnenl Well Wall NlefS'lo-0fod,Ecrt— _ Othe, _ 1 <br /> Vondonrg'Ate It(%) sof"116 Sod 9enr.9i l s 4"'C" ' <br /> eolechmui <br /> Cut-Ol-S^_n ice Well Cul-OILS—oe Wel Ranev al Z Cme6-CCnneCI,0n Repair <br /> Ne✓•Pu? -Pu R cemem Pum R6 d'r _•Raise Well Cann <br /> WELL CoNe TRUGTION l <br /> Dnlling Nwnod ud Roury Ar Rotary C Auge• -Cable Tcul t 1I Pont _ Omer <br /> Prop—ad Well ept1l 150 r Eacavaeon—1-LA-In cla ieler ::Open Bono- XGa al PaCJUGr-avd S,ze ,n(Pamelor , <br /> Gonduaa Caenq Ir d,ameter r Goncuxnr Zearg Depv <br /> Well Cising Dm—ter 7ThIneswGfiugwA.S'T1v1 Scrod� Steal Ie96 [ $ta'+lss$Wal C Olrer <br /> Grout Saal p ptn � Neat Camcnl(G+;p Degr'r'0pal weed - $and Camarasac*mi./7 gal waverWo Ile(20%SOirer <br /> Grow Plaument Shod ,PumpeFal -Olner - RetaaSm rAeeelletwor(nerve} <br /> PEDESTAL nstallod By - ,Aller m.P�onvaalx <br /> Concneie Pedastat DIm rulbn6�W)Otn M La^OIn R Th•C< - Christy Boa "Sove Pipe <br /> P ,n <br /> UNP $utmervbla=T,nDlna =OLner NP Pump Set S Stanaln2 Water_evel q <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK W'.LL 6E DONE IN ACC04ROANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS 6TATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> ATIN'ML1M 2a HOUR AGVANCE NCjF4S -REQO!RED FOR INSPECTIONS <br /> $1, 1 TTT� a,d- 'S V�cfve7SD'�ATE t,"3 0-17` <br /> 1 V1 <br /> I <br /> I <br /> II i I <br /> 1 <br /> I — i <br /> PAYMENT <br /> RECEIVED <br /> APR <br /> , I <br /> a 2012 <br /> SANJO <br /> NV ROt'ME TTMEN <br /> I H6i TH QEPAA <br /> ' I <br /> A TMENT USE NLY <br /> Appll:at,cn ACCOOt6O Bye' Cale O Ati Employee 1011 <br /> GIDiA In_peq,on By - Cele L SPECIAL Well Permit <br /> Pump Inepeca'cn By Dal• WAIVER Received <br /> Soil 80,"g Ina cn B Data ConelruqjI-We II Depth Q <br /> COMMENTS (/jam c(.e-,r <br /> P Racorved ChWAIN Amount Cate P•rmlV Invoke vWq IC/ <br /> CIaOe• Inb 8 RSm Rlsd Seneca R uesI <br /> I <br /> END U.% .�E__,PLwP cEavlr <br /> ypiaa <br />