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WELLIPUMP PERMIT <br /> swtae.«. oaart+. .wtwtMwaxo�r�n�..ur ,7 En.T TONAvwv�-s,oarTo�cA�sios aZu(U"U M <br /> wwrlr EXPIRES i YEAR Faw DATE"Uto <br /> fC40"S.00r S�R,'M .ATK _a? �, I PAR.CIp.Sta LwNotletAmIIGi55owt <br /> ioM.lo,now lJ.i T <br /> DwApq fly n J� CYTY7jTaTi�II YLLI/�1 !]L,(I' 1.7J�C}I23 ci <br /> [Cc-in pg.RA—Mik j�0,61—awn-cTe"Conamw <br /> i <br /> -- PIIOIq,^ — <br /> Cm-fiTATsf2i _ <br /> r4cswet -'C-57 r D-w Ovwr,�-,,,`_ Nom"N �. E WATwrD►Ts d i <br /> j <br /> !t�S.ifs10 PARTY: C?MiM "'COMTMCf'R7R Tlrf{T {.{{ <br /> Dawes"W ta&SAantnsa: G rwW $el 6 ie(4391); Do ane(4392'1,--Arsenic{4393) flf <br /> 1EII ia�eslaPrAale y!' 'yA0 +1MSN trg4s +at �14iter Y RAorftt np =3rAs SercpiF+��tssnenere,+An <br /> --�� <br /> TIM OF WYOeu 14ew W44 �Ropftwi art MI 3 W1 W 01w <br /> -34arrlopwV V*lts _!awe" Sai090-02) oarsrnYvr rlp� <br /> ":OutC}F3atThti WM :.?t?stF{�Jl1WIne vs4t 4answsl �Crosx-�.,ortxad�xt Rpws . <br /> fieTe F R <br /> -7 Rwae Wel <br /> (Dr"kft**d &W R?L5ry rot Rowy A,W -,3bk Tov 7 Push PO4-1 p!ntr <br /> P-/wadW** t-) pN A I:wAw kn x 6e7W*r ' L'I*.+s'ntiaftm 7 IrvvWPsdUC�SMR iefwMltr <br /> :: C-0r�ucYa G!>u� in wrtflMt t �,otrkxzv r_�siny v+RRh __ <br /> We*cog" --%Wn w h Ttpcirr essvC,i1 wA5TM Schm � 3,vo; _ pix%:r c -+5:*-"13:;tete: flyyF��--.- <br /> 1 OMA Sant Noah R YAW c rwn!/fit;e?*CV10 .n a'*0 It-) C xN a� _ tael[l�itfTOlt Yr <br /> �1>iirMt Ett}'i uo40s) �Ottfw <br /> !Qeeatt Ploceawd YerNd :: Pumwd Z Fee&FY "D4 wr Reter6a 1:Atx,*yraY.or Inca») <br /> !P i7/i, hrstplNO By -'Dr1Nr <br /> ^- �(Cowcrw Pods"CDlnnosiwts vAAM 14 ionath R TL-- r - Chrhtp Snit L Vow*P%w <br /> tQ� 8tbnrraORs 7;" Olt+w w ls`�'� R WSleew LaeM tt <br /> I 11ERFSY CERTWY THAT i HAVE PREPARED THO APPUCATXA AND THAT THE WORK WILL ITE DOME W ACCORW=WTH SAN ! <br /> JOAQtW COUNTY ORDWANCES. STATE LAWS. AND RULES AMC)REGMArIDNS. I ALSO CERTIFY THAT WY REQUIRED LICENSE FS <br /> CIR KHT AND ACTIMF VATH THE CALIfORKA CONTRACTORS STATE LICENSE BOARD AND THAT t AM R4 COWPUAMCE WITH ALL <br /> IYORKERS COMPElIIIIAT1DN LAWS. <br /> M'ImmumAw 940 R DV CE t4QTICE REQUIpED FOR INSPECTIONS-FLE„A.SF CALL 1,20,B)95;4597 <br /> slwlia /E32�✓LG� � z OAW <br /> fill <br /> I <br /> J tfit ` <br /> t j � <br /> f Y��NT <br /> t . <br /> --} 118202 <br /> 0 <br /> 1 i I <br /> IN cou <br /> k , t O WCA17k 1y <br /> s I I ► gRTM <br /> t t <br /> DEPARTMENT USE ONLY <br /> .... Calc A. <br /> DM <br /> W -RR <br /> 30! Dr R <br /> w I ARKK"t . MYok!A <br /> Ct><Mt b* CON PAMO d ? DO* SlrSric!Rtguest t 1 <br /> D E P A R T M E N T U S E O N L Y <br /> Application Accepted By �' Date 11 9.�o_ Area � Employee ID# S►� <br /> Grout Inspection By n A A Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date Mg L.I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS Well DBrri11+ kJPQZA000 <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Service Request# <br /> 0:5-,l 0P00q1q(;3 <br /> EHD 43-06 6/11/2019 1I 702,0-6 WELL/PUMP PERMIT <br /> i <br />