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NOV-06-2001 08:37L MOORMAN'5 WATER �Q�(�� � R.01 <br /> i . . WELIJPUW PERMIT <br /> • j SAN JOAQUIN COUNTY PusLC HEALTH SERVICES ENVIRONMFMALHGALTH DNLlION <br /> •�� 1 f 304 H.WEB&AVB,TKULDROOR SMCKTON CA 95202 (209)4663420 <br /> r� �oN•RBFUNIMILX PERMIT RXPLM I YBARFROM DATE ISSUED Q �� <br /> 1102 AuDREsIP���._.�!l� �!� r+>' i :} , ) wpN . )QCT) <br /> crTYrm' r r +itrf h�.`rr vw,� '7S r! PAFIXM SIZE 7 <br /> OWNBI <br /> Cfi'Y21 <br /> CONTRACTOR/ 1 OCYAft.. S V o it, : ml-5s rl JADDRESS <br /> CITYlZIP I Zh 1�.,r �1'� trt(OtVI: '� 7(y G57 LICENSE« �, DATE/ 11 <br /> GEDGRAPRICAL UODRMATION: COORDINATES X__ Y TOWNSHIP_„ RANGE_ szcmoN <br /> TYPY OB WILL 40 NHW WELL ❑ REPLACEMENT WELL a MOIY[ioam WP11 f O O MER <br /> II I <br /> i EMALLATION. C WBU SYSTRM REPAIIt Q CROSS-CONNECT REPAR 0 VAPOR BXIRAC`n0N W6"k <br /> TYPE OF PUWW4,. P S81 PT PLRS7 WA LAV "` '••rL <br /> I O OUT OFSERVICE WELL G GEOTECHNICAL 0 Q SOM BORING 17 DES'iRUCMNr <br /> >tnrrrr�. usy Tym OF yam CONS fTt'RUCTION SP_R.[_'I'ATION <br /> ❑IND TMIAL ❑OPEN BOTTOM WELL LXCAVATION DIA !'1 CONMCTOR CASING DLA ` <br /> O DOMESTIC PRIVATE 0 GRAVEL PA Nl WELL CAsm TYPE ��—,I(- WUL CASINO DIA <br /> it)PUBLdC'MUNICIPAL a ORTUEN RE D GROUT SEAL.DEFM!y 0 ., w 00SPECIPICATION <br /> OBMRIGATIOWAG OCT 15 2001 CrXERGROUTBRANDNAMPA <br /> , <br /> a MO�M)RWG SAN JOAQUIN COUNTY; GROUT SEAL PUMPED: 40 YES a No <br /> PUBLIC HEALTH SEAMCES <br /> O CHRISTY 1QX a STOVE PLD$ ENVIRONUENTAL HEALTH n!v'SeCojgCRETE PEDESTAL BY DRB.LBR: O YBS D NO <br /> APPRMIMINTS WELL DWYM <br /> PROMSED CONSMUCMWDRLLIING MLrmOD: MUD ROTARY—.ZAIR ROTARY AUGER CABLE OTHER <br /> I SICREDY CERTIFY THAT I HAVE PREPARED TMS APPLICATION AND THAT TIM 3VORK WILL BE DONE IN ACCORDANCE WUN SA-N <br /> JOAWN 00UNTY ORDiNANC IM STATE LAWS.AND RULES AND PSOLI A1tOn 1 ALSO CERTWY THAT MY C-P LICENSE 16 CURRENT <br /> AND ACTTVE WTTS THE CALII+ORNIA CONTRACTORS SPATE L1COM BOARD AND THAT I AM IN COWLIANCE WITH ALL WORKMAN'S <br /> COMEMATION LAWL <br /> MINIMUM 24 FLOUR ADVANCE NOTICE REQUUIIED FOR INSPECTIONS <br /> TM.F 1'.•''•'.•• DATE /'.> > l �� <br /> — 7b.kill <br /> ZMA0.l4 9 <br /> fPJMH 0M/ M WaL � 7 <br /> f{ <br /> #T-1 <br /> st 1611 <br /> • <br /> i! 1 1 Lr a' ~ �Mlw ywir�'•I►wtr►" `may �— <br /> w <br /> w M L1 u ►� P+ rlll9�hh <br /> i w w r a w N ICU t»wb U.. <br /> J Y' DEPARTAI>M USE ONLY <br /> Applicitioe ApceptM By��k- y�1ti'1�.•/LGA �I�JLG�. �/�� D�[A /4 f/ ly ,are. � BMP <br /> Csmt Wpecdctt By o.rA Pump I-p-md By Date <br />