Laserfiche WebLink
WELUPUMP PERMIT <br />SAN JOA<11NtaCOUNSYEN+JIRONNENTALMEALTNDEPARTTItW 198$ EAST HAZELTONAVENUe-SrOCKTONCA06205-6232(205)468-3420 <br />NON-REFLINDABL.E PERMIT Www.& hd EXPIRES 1 YEAR FROM DATE ISSUED <br />... _ <br />--E� __ <br />JoaAaSDRES! J,� � <br />CRCSS 5l=)N- � <br />OWNER NAME - �1 �c,.r..,+Y=lz}L�.1�1_�.y_ PHONT' _ <br />OWNERADORESB CITYISTATOMP. <br />CONTRACTOR l�i �-1.\._� LDL A—_ <br />CONTRACTOR ADDRESS [j <br />- ) 1 /7-- CmISTATE1� POLA- i�-, <br />tt WW' - - <br />SUBCONTRACTORICONSULTANT <br />RRACToRICONsuLTANT Aomss.®.,_-.,..m._.y.._.._ CITYISTATOZIP _. _. _.__ _�...•...,..�....____,.,....,. <br />C,:T7 C-61 t1i79 rJtllnr ttUSAriERExPiRATItN DATE,_,, _ <br />PARTY;. OWNER COWTRACTOR SUBCONTRACTORiCONSULTANT <br />DOMES= WELL SAMPLING: COnerW MinWaKl oil%r,n Bacteria (4391) Dibromoclgoropropans (4392) Arserda (4394 <br />-- <br />_ ;rrlgatwrtlAryiaN!Rr.11 lrWusNfal Warbr Ouafty MatKortlp Sol! SampGIT{yCharacteriZailan - -- j <br />Pub0cWater Systern <br />$t5dbrot;fir�m WJN¢. f eral ib^uxttaAmaar i+r.7ht Nymow <br />------ -- <br />1h+_k 4f _'r M New WMI R6ptaeeMW Wa Wet Aft&aIjon lu 0dit f0rT UIRer _ <br />.. 4 of walla Scil $orinp(s) .._.--....... _.. crt °P°`5' CirloloO%ut ra3 _ 4 or bang, <br />Ot-Of-Serrvfce Well Out•Or-samea Woq Rope" Cross-Cosrmebon Repair <br />,Driglnp 1bUwd Mt.d Rotary A,, Ratary Atajer Cab1a'Tool Posh r6rit 01her-_ ,__, j <br />Prapofed Welt tJepUr _, Eftav"On —. V 4.._. In damalor Opan Battrri Gravel P;aWCravet Sizes ___ in daamrte <br />Cmductor0m4n9._._. _...._ inam*tcrr i CoewusterGasingDgnh .- . ... "A I <br />WeII Casing Dlurn ,tar ­_ in Th4vmnAGat*WASTM St'ttcd __. _ Steel Plaetic $tain;esa S14el Other--- <br />GroulSrat Lk•,tr.____ p Nest C4man6(4r7bbay15•fd0wniaA, Sand tamcrti_ sackrmw7�•flvatrs <br />{ Brr:rCriYl@ (28'k sok1s) Other— <br />PE6f STS &t(Nled By Dmsr fiuump Convac%or '"fC 0ther---nL <br />_-- Gwlewte Pedetsiaa tSl+TwafiOru Width — 1C I.u5tG7 __ <br />�Qyrt? SutxnertolT>te TurAirM <br />Other Hf+ v _ mP T— Ry Standnx}WareLaYbl__i_y -tt 3 <br />I Hf.REaY CERTIFY THAT t HAVE PREPARED THIS APPLICATION AND THAT THE WOR WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE MTN THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM iN COMPi.IANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINI 8 OUR ADVANCE NOTICE REQUIRED FOR NSPE T.10ONS • LEASE CAL: .: r, .5j-;'697 <br />+}1 <br />5uiNesa _ �� TITLJa DAre f <br />,✓� jAE.PARTIARNT USE NLY { <br />Application Accepted sy r-�I a _ Data 4� _ Ara- <br />, Eml toYea itAY 1 <br />GroutInapets-By _- --. Date -- -- SPECIAL Well PefMit <br />Ptimp inepechm By �_ Data r� WAIVER Received <br />Sal 8oro+y tneptxil DY -...-: _.. ___—._ _, Dada - .--- - Corlatructod Welt Depth <br />DOMMENTS 1,,L1jt • k 1 x <br />C-w4Recavar! <br />y� <br />—Chid <br />Dam <br />se t ` la v+iea_W�I>d11 <br />� <br />�aIrk <br />4 <br />fA <br />■ <br />,✓� jAE.PARTIARNT USE NLY { <br />Application Accepted sy r-�I a _ Data 4� _ Ara- <br />, Eml toYea itAY 1 <br />GroutInapets-By _- --. Date -- -- SPECIAL Well PefMit <br />Ptimp inepechm By �_ Data r� WAIVER Received <br />Sal 8oro+y tneptxil DY -...-: _.. ___—._ _, Dada - .--- - Corlatructod Welt Depth <br />DOMMENTS 1,,L1jt • k 1 x <br />C-w4Recavar! <br />y� <br />—Chid <br />Dam <br />se t ` la v+iea_W�I>d11 <br />