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v!T <br /> APR 1,,,_,Jiz WELUPUMP PERMIT (-eSDiH. aGk'ijl� <br /> SAN JOAQUIN COOMrY ENNRDmgearm HeALrN DEPARTMENT SME"YMNN3111CR-SmxK CA68202.(209)468.14]0 <br /> NON-REFUNDABLE PERMIT CALL(2091963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> FA"DDRES$ 13cils13cils E. 4t6%,,A rs&-- ) CmTLP L OV-OFr2 CA-C/I�✓,"„+J �•r. APN S/111/n01q PMCIL BILI LAND IIsi APPUCATION0 <br /> TEcc,. 1 R,6ts{.a1{!(R (t (.(-TIE.Jb, PHose-2lu—G2G-6Z2t4 I' 1t I'0 fog �ER�n'o G�El.7boo PA2Lew(�h7 CImB�TAAIWlEFF -VAArO N4rc,0tO Ty„1862.(6`1 <br /> KG • 0d �N� 06R Z � T Sza r-fHONE 5CM9-N7 `pwtEM SO.YCLy FILONfIkGLL fLD. ClrrlerArWaP N i n i”to CI41y <br /> SUBLONrMCTOR c 2S, I w1G C�1r}(�Oil -ah - - - .PIKMR R 16-ea 1-#0011 <br /> SUBCONIRACMR ADDREaa5N1lY D J L'f/l�¢EEa K Tab . pCIT�YIBurULr SAocaAIr"skw O ' <br /> uclME ❑C-S7 n C-61 n Doe Gmel'~< v+ uMBeR �vJ'TY dPIRA DATE �/ �i1�-.W I <br /> OeaaRAPlatµMauuTaN: CGOO NaW% Y Tawnahlp_ Range_ Sactbn_ <br /> IMIENKD We ❑Dome{UdPdvala 0 brlgatiaNAgricultural !l InduEtdel O WMm Quality MOMOdng f I SDN Sampling/ChanderUation <br /> O PulAc Water System <br /> aan.nm rran Ova M.. <br /> TYPE OF WORN 0 New Well 0 Replacement Was I Web AReralloMNadlgcation XOlher <br /> 0 MongaMg Wells, f of wage D SON Bodng(s) a camps O Geolerhniral .0t000pr <br /> D OW-Of-samce Weg n OUI-Of-Sarvcn Weff Renewal U Cmu-0pnnedlon Repalr <br /> n New Pump D Purnp Replatameni O Pump Repair 0 Raise WN Casind <br /> WELL CDn3rKKDrON <br /> Drilling MPNod n Mud Rotary D Air Rotary O Auger 0 Cade Tool n Push Pow ji, ODRr V';:1, fi4J\i'V�- <br /> Proposed Wall Depth.ft Excavation In diameter 0 Open Boeom 0 Orsvel PsddGmvel SI.._N dlemebr <br /> I Conductor Casing N diameter / Conductor Casing Depth R <br /> Well Casing Diameter_N Thick N WGauge/ASTM Shced LI St" 0 Plastic 0 Sleinless Stage D Other. <br /> Grout Sul DepthR 0 Nast Cement(94 t6 Deg15-10 gal wal" O Sand Cement aackmtr//gM watar <br /> 0 Bentordte(20%aagds) D Grim <br /> Grout Placemanl Method O Pumped ❑Frn Fag nOther 11Reerdrttl/Accelerator(name) <br /> pCD�IF 7AL InmPW0 IDarMIsr D Pump Cohador Other <br /> ❑ <br /> Dlmanalon:Wltllh R Length flThMA N DChfWtyBox 0 atova PI <br /> ❑SubmeraibleD Turbine fl Other HP PuMPSOLft StandintlaM 0. <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, TATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH Tl CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATIOI <br /> IMUM 24 HOUR ADVANCE NOTICE <br /> BIDKED NOTICEREQUIRED FOR INSPECTIONS <br /> TITLE �I <br /> DAM <br /> E <br /> o u, IVV <br /> al. . <br /> 4 <br /> a�.; 11 ( D 9A RTMENT(fL}I''8^EIONLY y1- <br /> ApplicalilocaptedBy ,�.a-,kjJ' Data -I I � Ana. Employee lC* �1}�- E 1 <br /> arm InrSP o By. O6M SPECIAL WBII Permit <br /> Pump on By Date WAIVER Received <br /> Soil Bor II Cion By Data Construct"Well Dapth R <br /> COMMENTS .I <br /> PE I SC I RauMtl CMeke/ Amount MrrnW <br /> Codn Into 1 L -CaD"� RemlNatl Dab SaM.R unto Involca6 MNllld <br /> 23, 3$ IL „ , sPcc&q 731 <br /> boa wEuwarPeavT <br /> wane <br />