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WELL`/,PUMP PERNIft <br /> '0,�1WH� �S <br /> 8AN WNGODNIY ENV IAtONMENTALRGLTII DCPARTM¢M 364 EW¢¢[n AVE 3`AFL•STOCXTO CA93303-G09)/6/JiIO <br /> NON-REFUNDABLE PERM CA IT . LL(209 953066 rOR INSPEU16RS EXPIRES I YEAR FROM DATE ISSUED <br /> n n y <br /> JOEADOREJE 74/ Ce/. r eJ2ar„�A.({-.— _ ._ _-- ._ cITr21PlrAt.� - .'/-•f �o�� <br /> C0.05T MPYLT nn^A^�f� �='�11'PAPC¢L512[�y!a7�7 LAND D¢EAPYLIGTION N. ' • p <br /> • OWNEPNAMC LF- <br /> OWNERADDPW <br /> CONAacToR �/r'}�r,n �PJ•..- IE.�%rl�. -- _ PIION[ /'7 <br /> CORAC¢ORADDPEY�(aJ' •£'.:;•�.//^(�%_—.. ..CITY1StATVZ1PIr-��`T M <br /> SwomrHaAcToR !^ - PHONE <br /> $DECOMRACEOP/ADDRLEE .CR�jjY/STATUZIP <br /> LI[LN¢E QGST OC6I ❑D:9V. OONer — NUMDCW� R EXPIMTIONDATC <br /> G¢OGMIIIICAL INPDPMA IDNI Ceordihatu X - V Tawnrhlp� flange_ 5«IIDn <br /> IMENOEO USE omade/Pdvita "'O lydgnloolAgdoullmal' 'O Industrial = Cl Winer Qwlity Monitoring"'-' Cl Soil SRmpling/Chencndntion <br /> O PabIIC W.W yak`m' - <br /> Nmrtem Ra Own; w y.0 - nrt unn na - <br /> TYPEOPWORK aw Welll, 0 Replacement Well 0 Weil Alt6ndoNModiflutlmi Cl Other <br /> O Monllgdng WdQdN af�vlls gSoil Borings) 'eart,00w- OGaw.homand . aarbodoEl <br /> OOm-0SSEMce Well' 00u1-0LSeDIeO Well Reneml 'O CmavCcete.tian Repair ' <br /> ❑New rum —01arrepReplAcerrient . .❑Pure Repair <br /> WELLCONSTRUGTIION/ - <br /> Drilling Method 1311 Rotary CI Air Rotary 13 Ask,r ❑Gble Tool ❑Pmh Point ❑Olhcr <br /> Proposed Well Depth ,Hfb R BLuvnion. I l In diameter ' OOpen Bottom OGra"IPwk/Gn 1Slu In diameter <br /> OConduator Cuing - [scissorter / Candwmr Cuing Doll, � It <br /> Well Cuing Diamctn�in ThItkhnUOwgdASTM Sched— ❑Steel aftrirc--O Stawc-i )SI'ebl .❑Oiher W <br /> Grout Seal Depth R' Cl Nast Cemenl(94 IN bag/J lOgai wen) OSand Cement «. ,_ sack m4/T gin ogler <br /> not .solids) ClMinuhcNier Spa S'wilda9i Name - " iCl Spua on File IOSpaa SubminN F . <br /> Growl Plaeamanl MvlhoA' Pum M:OPree Fd'I OOlher - =^ ❑Retitdanl/Accelealor(name) <br /> raja" Installed By ❑Driller 'C Pump Cormier O Other <br /> OCos.o.pruIM Dlmeul...:Wldth_R Len h RThick in ❑Christy Doa •OSto..PIN, <br /> OSubmenlble OTrbine.-O01hcr - - - IIP - Pump Set- = • RStandln _ Water Level R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS-APPLICATION•AND THAT THE WORK'WILL Be DONE IN'ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS, I ALSO CERTIFY THATIMY REQUIRED LICENSE IS q <br /> CURRENT AND ACTIVE WITH THE CALIPORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM INICOMPLIANCE WITH ALL Z <br /> WORKERS COMPENSATION LAWS. <br /> INIMUg HOUR ADVANCE;NOTICE REgU[REDr FOR I NSPECTIONS <br /> SIGNED TrtLe �/_ - .DATE/ if/a7 a <br /> • m <br /> i <br /> r I _. _ <br /> re <br /> '0 <br /> EN <br /> T <br /> 1 ;/t DEPARTMENT USE ONLY-' •"- - -r <br /> ApplicationsAccepted By �1 —�- pfte 2be 0 Ara Bmployec lDq `�u4S,�j� <br /> Grant Inspection By Dab ❑ SPECIAL Well Permit <br /> Pump Inspection By L Dan ❑ WAIVER Received <br /> ti <br /> Constructed Wall Oepih R <br /> COMMENTS <br /> PE SC Rualved Amount Data • m <br /> ParmlU IneoluN WelI1M <br /> Codas Info B Cash Remitted' Eervlcv Breasts <br /> H3bG l8D r ' . 9ps.tyAJ ' 1 J`1 S pp$'10 - • <br /> • .E wetiruMe rERMrt <br /> Ialawl.nmWs. <br />