-1I_Qq" 26,'98-07:45PM,PHRKHS ES P.71 P- I
<br /> . OAPPUCATION FOR WELI../PUMP PERM t�r--fl
<br /> SAN JOAQUiN COUNTY PUBLIC HEALTH SERVICES � X )0)
<br /> ENVIRONMENTAL HEALTH DIVISION
<br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 Phah�_ t �G s�
<br /> (209)46a-U20
<br /> 1401(-PFMX9AMkf PERMIT EXPIRES 1 YEAR FROM DATE ISSUESNQ���Kl�
<br /> FAvvLeth!c TtlpRaftrJ JJ
<br /> A—trCAT1ON 16 l(t$W 1tY MADE TO THE GAN JOAOUPW COUNTY FOR A PUMUT TO COUSYMCT ANO)Oat tmTAt1••THE MIOAK I1 erpmato-Tia*APPLICATION Ir MAK IN COMPLIANCE-TTi(
<br /> n� `r �+.I-1•TX. �,�••'1't �.,,_ PNK=fI a2FlA.PN�jf� k ISAM
<br /> JOAOW COUNTY OEVrLfJF'UL q TTETtf,CAAMM 8-11 53.WU THE � OF SM!JOAWINCODKIPUII C HEAkjH SE"ICEB,ENVRxON<EWP. ACALTH UMl3*N.A?I4 177-
<br /> JON AOOcESSiORAMa Cfre
<br /> a—FA'O wws F FtLvtd7 it 1 U+CGNIk �Ofq(ETfer EOG� •r �..;_. (I. _vNoh€•i��Jr
<br /> 2iG(W�fjY{ec54•;S�"�t*7c3o �lSt° i"►
<br /> coNTwc;Tow t:4Ql,� I*Y.G_titi+Lidt'�M•(dS[�f�.l•4a �_ ®�oorcex ucr
<br /> tx s CONTT
<br /> CA
<br /> TYPE Of vL'ELiI mf- b(NcwvvrLt ❑ 11mAcEF"EW wzu XI.—vv"4• ❑OTMCA
<br /> {❑ W9TA11ATNTN ❑WM HY3TXM RSPAIR ❑CM/tif ca,.MCT I-cp-A Cl VAOOR EXVt CTIOW WELL i
<br /> Ll u..r Q R.P�r H.P_ Min 14"J"s,SET__-,_�_ FIRST WATER(EYLT._
<br /> FIT,-fJF WMvj
<br /> SJ OLfrCf'-TiGRvr.L�n,;l;, ❑ r1,OvttY7i l:-Al WEU_/ l r4 me-a's
<br /> UOF6 RVCTION;
<br /> iFrT�Deo usE weoFwcyf CONSTP-IcTroM fgflclfacAm?m R
<br /> ❑tiMVMAL Q OF"eOTTON aA.a WEu[ICAVATION $ i!�a� aA,of CONo++eroa CAw-c 0
<br /> ❑ ooMCIFTIQ ROVATE I$ARAUEL PACXMZ£ f - TYPE Of CAQMlvTwep%'c �IIL ��MAL OF WELL CASING 2-!-[(,,4 O
<br /> ❑ MKbCffiUJ OCIPAL ❑0MYLM 0CM14 OF SMUT CLAL YfVW CATgN R
<br /> ❑ If+WOAT1ciwAo ❑OTHER OMfWT tm F
<br /> MSTAL7,E'ofppDt{Y `I"elN•Q. 0w%.§T ORAMO NAME _ �-_ »._
<br /> WMONTTOM"ll / ORDVT SEALPUMPEO:I6[Yr ON.. CONCVZMPEUE4TAJ,UYOfOLLER:W1�LY— C.- S
<br /> 01~Y.DosTw �'-J�1 � tocx"I CHCA6FTtA roxJVTOvE P _ 7 s
<br /> PROPO SFA COKxly MT1 WDMLIING PAETNOO; PIUO POTARY AIR AOVARY UOER N 6 A GIME OTkvn
<br /> [Hf�EHY CFRl'IFY MAT 1 I/AV£PI�PAIpL4 TN/S AP'RICATgM ANO THAT THtI WON(WILL aE DOr+f 1N ACCOh7ANCE WlT1(YAN JOAFJtIt•(CGUT(TY OK7WNVc-'E0,RfATC tAwO,ANO Hl/l.F.n/II+O
<br /> nECVCATfONIe OF VNE SAN JOAWa[COUNTY. NOME oymm oR L1C'CNtEO AoCifT•II 01094AYVMG CEATIPM5 TME MLLO9A"4:'I CERTIFY TtaAT W THE PFP7\J"AA/•ICC Of TJ(E WDTIS POR WNtCH
<br /> ywg 9-coufT 18 tusUEO,I miAlt
<br /> T•RiSUeCGTTOQoPATS COWAMOArl"IA'W OF CASXOP1U,.'CONTAACTOW4 ftUeNO on RUM-CONTATINM 9TCNATURE CER('R69
<br /> THEFOWDIMP44! 'I CEIrrtET TN "m
<br /> Of ICK WORK►OR Y441CN TWO Pft04M IR IeBUM.I RHALL EMPLOY PERSON®SURJLCT TO WaRnAAN'e ItOM"wviAT)or/LAWS Of
<br /> cltlfanNtA_' T ts7LARa a AiN&%Ce FOR L1 AMMLAR=lllzr="*Rs Ar t,xI"f /�-Ka. CtDUPLETE VOAWLNO AT(.cWCR Ff 1'9 MCaVtpeo.
<br /> x 4 TRI. 61-71 t
<br /> o ..
<br /> Plot PC"10—a+saw sear,. 10
<br /> T, NAA G of G.Kt;,'%OA MOAOS Z AIMNT TO OR QOV"004 THE PA]PER'SV. A_ LOCATION OF PIOUM SMA"UIePOSAL SYSTCAt OR MIOMM
<br /> 2. OUTLAaE(w,14%—to wry @VkaG go.I Mug ANC No"m DRIRCTION, EWADMON OC SEWAGE 1:1111SCSt1 SYSTCM0.
<br /> 1. NIMCP/6fi*P'(F6 Wrtl"10 ANC WCATICN OF ALL WMt%W,AND P'ROSIUSeC S. LOCAM-0 Of%ft"thtPPael"MA OF OMC M AV0ft O"TV IIY,
<br /> iTRtKlVrgi+S,*#t.% OTNO"VP WO Aft"St"M PIAT10ttr.0111ye4VA.Y5,ANO WAUC0. - ON THE P7tiIf'Elfl"f OR AO"O"PMO*Mry.
<br /> ,. "v- �.'!/.}^_�Y.TC.:�G...r.i ••;• SI_.�:�.. L A .. : r ....... ../.. .J.._.. 1
<br /> 1 1 (
<br /> 1 ...... 1
<br /> •��,1�. ,�.•.4tl.e7x1-I�-�z►L�'�...:1 .�....�11i11�.
<br /> c i
<br /> i
<br /> t c
<br /> .... ._ ...p... .�.. ..�...t•r••.j...,.ji......�................ . . :I� « .....a. ..*......I......5..».i......c... »..Y.....,•.....
<br /> ..t. t I t •:Y ...�. a ..�. 1....6...
<br /> .. _.._.... -!: .�... ..; ..q.. t »t,.»�.....« .. »...j......'.. ..t ..I. ..e.. .1,. ..`. .'-.. /. 1 I s
<br /> t f I f 7
<br /> • i r i t I } i I � �
<br /> o1�AwfMaeltT vat aM.Y (
<br /> O 7U C)
<br /> `
<br /> Aasf.Nf.I•.Aewfc.M 9yf.�- -i �/,,�--' a,a. ,L�tz? -c.�% - `l 6 A.�. n
<br /> Cs+:.e:•ar - -� -""7- '� / .�G{' /V�-
<br /> ACCOUNTWO ONLT: AIDS
<br /> Pc cotta PRP" APAovw paAffir D c"Pe"MASN 104"WNf sY DATE low"ASERWICS PtEcTurvI Nulaat 1 ------
<br /> C t� �t
<br />
|