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.......... <br /> WELL/ PUMP PERMIT <br /> f14Vjjkt)\MF.X'TAl-HEALTH D#,PAi(T%fFVr 304 C WLBVR AVE)-Fl,-SIOCI(TON CA 9:,202 -(209)468-34.10 <br /> NON-REPuNDASLE PERMIT CALL(209)953-7697 ix)R INsrE4(-Tj()%S EXPIRES I YEAR FROM DATE ISSUED <br /> job Autmr-Is <br /> Cwu Swctm AM mcm S 172 <br /> Owmev NAw --2303 <br /> OWNER ADDRIE&I CMWATV-Lip <br /> CONTRACTOR -,&,e:r AC-1 i-1 jz, 216--girt V <br /> CONTRACTOR ADD— <br /> PHONE <br /> U'J1COMkAC'TOR ALOOKUS <br /> Ltcrmst to C47 OC-t,l o D-o 4t,. t,'7,,,f cl..T..,l DAIF <br /> TawojA4 R&*Rr Secuo <br /> INTENDED Ust 0 Drurararic PnvaiC L3 firtipajonifticultuMl y 0 Industrial 0 watorqu2tity manilo.ing a Sail Sampling L7u�lctc»sartiw <br /> ID Dublk Water 3ystt� <br /> Tvrz OF Woux?M-W61 0 Rvoltaeltwnt well 0 Weil AhatationlModtrirstrnn G Tv%lime 0 cqha <br /> 0 motuu--init wcit s) rotor """e"Itb-Ap r]6cxdchftKAl-- <br /> El Well o4situcoon tj W-or-scmw.We 0 Out4X-Service Well littitews? <br /> cw Pum C3 rn Pum- <br /> W"L CON'STRumoo <br /> "int Method 0 Mad Rotary 0 Ail Rotary 0 AW a 4Citbir,T.01 0 Push l"00' 0 01hey <br /> P-Powd W11,11 dianitur 13 opft Byu),n 0 Gravel Px*I Gavel Sin---in diatnew <br /> 0 Conducuv CondlIzior CA%tng r-epth­'.-.'-----­--,'—ft <br /> Well("Ing DiattxYer rn T'Jlitkn,%VC4LSc)AST�MSchcd__._,___ Osumi opIr4jil; asbLinicustat! 0 Odw <br /> Grvut Seat 'Depth-,__fl n Ncitt Crnxct(W in rwsx/,I-joXj 0 s4rA Ceffent— —,m!*mix.11 P1"w <br /> Beft;mte ",ds) 0 MAInufActureT SM%ficlids % Namc D Spats nn Fila D Spew 521trmitted <br /> opavw OFree mall 0 Other. C3 Reurd"I I ACelenttrn(olilna) <br /> MMAL I astifted 8 0 DMICT 0 ftnv etwinac:m 0 Other <br /> i C7 Coacreft PWOW Diumnoolottai Width A lin h it Tisick n 0 Cb gent 0 5""Pipe <br /> PUMP Totbine 00d-___ <br /> swiding Water tow, rt <br /> 0 Uncaud 0 CX)W <br /> DopthtoWaver_-ft 0 Cuing tobelterfo"W from.___ft lo--ft <br /> Staboiil Milutrist a New coawni M lb 0 Sand Cer,"l--sack mix 17 pi water 0 aentay"It pti" <br /> 13 AmIDA'tc(20%sol ds} 1)Manufx0to'er Spa%., da % N*= <br /> 0 sp=,"File 0 Spec;suttriahad <br /> n"Rawallolotliod 0 Nmpd 1)Free F-All <br /> C"Dinp4tnt,with Mushroom Clip ft below SrAde 0 C"I. <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS AYPLICATWN AND THAT THE WOR-K WILL BE DONIZ IN ACCORDANCJ:WITH SAN <br /> JOAQUIN COUNTY ORDINANCEr., STATE LAWS. AND RULES AND REGULAIIONS. I ALSO CERTIFY THAT MY RZOM"LICENSE 19 <br /> CURRENT A4D ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMM14AI-AN LAWS. <br /> NCE NOTICE REQUIRED FO CTIONS-PLEASE CALL(200)953-7697 <br /> Tyr" D.,, <br /> -7 <br /> 44 <br /> R E NT <br /> -- t <br /> A <br /> A <br /> --4 L <br /> RTM My USE V <br /> Apphwi(m Aoc��ptod 9y Arear <br /> E-00 <br /> 'y <br /> G�oui lospectien By <br /> Pump Inspection By WAIVER Received <br /> Datruaiw,.Inr^4 ion By Datc C"atnicud Well A <br /> Comm eNTS <br /> PESC <br /> Coll" R=od Date -111vttifto well 11100 <br /> Serwke <br /> - --------------....... <br /> PHD4342-006 - <br /> MASTER WATER WELL PERMIT <br />