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RYTE OF rumor <br />yE40EaTRUCTNfw: <br />APPLICATION FOR WELL/PUMP;PERMF' <br />PlRttf WATER LEVEL O <br />❑ BOR BoISNO IF <br />SA.— 3AOUIN COUNTY PUBLIC HEALTH SE.s`"'ES <br />OF WILL <br />❑Orin DOrTOM <br />❑"NAVEL PACKMZW <br />0"wit, <br />❑OrNER <br />ENVIRONMENTAL HEALTH DMSION <br />A <br />OIA,OFCONOMjER/CA7DIO p <br />OW OF WEIL CASINO Z � p <br />SPECIrICATION A <br />"rout MOND HAMS I --I I�T F <br />CONCRETE !'EEEETAL #Y DISlLE1G UJ YM 0. S <br />304 EAST WEBER AVENUE, STOCICTON, CA 02 <br />RECIOVEE By DAIf �� <br />(209) 468-3420 li <br />d <br />NOR-RIFUNGAKE PUNIT EXPIRES 1 YEA FROM NATE 133911) <br />AIR n*TAny AIIaER I, CANLE OtNVL _, <br />mewspi.1. he 7rlplk.l.l . <br />AMICAIIIIN In IIFrK SY NIAM TO TILE SAN JOAONIN COI}MI V FOR A JTRROT TO CONSIMMY ANOgN MEIAIL TINE'" K I710CF0017. Ties AITLICAUD" It LIAOE IN CDNOtIANCE ynII@ SAN <br />JOAO" COUNTY MWLOAMENT TFILF CHAPTER 9- 1116.3 AND TAT STTAND/AFOS OF SAN JOAOM COUNQTY�ijV.RM IINAL�INjWNVICER, ENNROMAENTµ HEALTH TJMIRON, <br />JOe ADDTIFBrI"R AAi!_T��_ _• <br />-S• /7 ��Q / t.1.i� �'�-y.1��I CITY _ J / C/� 4Jy� �^ —��( C,4 PARCEL .RETAIN. <br />�h <br />aAeIFR'7 NAME Sell) Jd tl <br />GIGYG M1O11F ' <br />7 A,orw <br />CONTRAC TON B .� RD <br />_eeZ��Zs�Il�L✓A� <br />)j <br />G N Go AOWNlss_[.y /QD.E' 3� _Pio visr� 1!O AI�NFi37y- j/�qs <br />M/S CONTRACTOR <br />ADDNEIG p UCF ATONE. <br />TY OFF „FF&y.I�IFAP1 ❑ NFWWrLL <br />❑ RFRACEM NI WM ❑ MONRONINO WFLL. ❑ OTINR <br />❑ INSTALLATION <br />❑ WELL. V"tt A REPAIR 0 C"DSS-CO/DTCT FIEPAIR ❑ VAPOR EETRACtbI4 Vft L if J <br />❑ NL..O R.P.. <br />H ■ DEPTH ANAP SET rr <br />RYTE OF rumor <br />yE40EaTRUCTNfw: <br />` <br />17 OV?-aF-.EFIVICE WFtL 0 MOMMINCAL WFLL F 'F <br />I� <br />PlRttf WATER LEVEL O <br />❑ BOR BoISNO IF <br />INTENDED VEE <br />❑INOUSTRIAL <br />[jDOME/11CTTWAlE <br />❑ ItrRLICAMVNICIIM <br />❑ IRRoAIIONIAO <br />❑MOMTOISNa <br />OF WILL <br />❑Orin DOrTOM <br />❑"NAVEL PACKMZW <br />0"wit, <br />❑OrNER <br />CGN.RAVCTION SPECIFICATIONS ' <br />DIA. at WELLEXCAVATION I <br />TYK of CANNOO T"ts-C UV �-�!4 <br />�m <br />"Emil or OROAt SEAL U, T0. 0 7 <br />CREATE NMI. RIeTAURD BY' I 1I <br />OIIOUT SEAL POMMO!❑ Yw [I W. 1! <br />A <br />OIA,OFCONOMjER/CA7DIO p <br />OW OF WEIL CASINO Z � p <br />SPECIrICATION A <br />"rout MOND HAMS I --I I�T F <br />CONCRETE !'EEEETAL #Y DISlLE1G UJ YM 0. S <br />APPIIDK- DEPTH <br />RECIOVEE By DAIf �� <br />LOCILING CIRSTFR BaNAAOAE rTPE <br />d <br />PROM1140 CON.TRVCTIONIEIRUNO NIETNDOI MUD ROTAM <br />AIR n*TAny AIIaER I, CANLE OtNVL _, <br />I IIERERY CERFIFY THAT I HAVE PNEPARM 7188 AAVCATION AND TIIAT THE YYOIK VML RE !LONE M ACCOnDANCE VAIN SAN JOAUVRN Cau111rY a1811NAME1..IA7E LAWS, AND P7AE8 AND <br />RFd1j ATIVNII OF TNR BAN JOAOURN COVNTY. NOME WARNER OR UCENWO AGENT'S BSBNATURE CEIMrFIl7 TIT FOLLONING: T CERTIFY THAT IN THE PERFORMANCE OF TIT WORK rOR VAIIC10 <br />TIRE PFrAaT IN IR4LT0, I SNAIL NOT ENn oYPERFON/ "itet TO WORKMAN'S ec"PENBATgN LAVES OF CAtwcORiff&- COI IRACTOFTF HBP"M OR BOB.CONr11ACT.q SWNAIUM CE7"/IE7 <br />TIT rOLLaY"N"I ' 1 CERTIFY TIIAr M TIM PVIORAANCE OF 111E WORE MR YRNCrr Ions Effort IF ISO". 1 SHALL IMPLOYIr%molN SINInCT TO WORKNIAWN COMT(INANDN LAWS Or <br />CALWOR IA.- THE APPLICANT MINT CAU <br />24IIDVRS al ADVANC ON ALL ""TATTED INSP[at1DITS At rr87H 47.1428. COM!{ E7E DM14WINO AT LOWER AFMA FROWN". <br />Bk.... x r�a,�!w L�./t +�TIa. CE2 '�+/.�'t[_Cit�'F AW44 AAA ASO.r G.1. 11/a <br />PLOT FLA+. 0— I. Se/N S.I. • N i <br />1. PAAIFS or SrnEFTA ON NOAOB NEAREST TG OR BOuRIDmu 711E rT101ERTY. 4. LOCATION OF HOUSE WwAar alameAL BYs7FMan "marc B[O <br />!. nttttw Or 111E roo"ATY, OMP" FN <br />OFNFIONS ANO NOr" MMCTIDN. EAPAHtI M Or WWAOF DISPOSAL VY7TIM6. <br />?. aH4FNIVONED OVILDNES MIO LOCATION OF ALL EILIB"M ANO PROPOSED S. LOCATION OF WTLL7 VMRM KAMM OF ONE IMNOREE, rety M. <br />STRIMI'VIIES. NCLIFODM COVERED AREAE SUCH As PATIOli. DRVEWAyB, AND WAIXS. i- ON TI E'Fr10PEFrrY On ADJOIMRNO rnonirrY• <br />OEPARTMOIr USE GMT <br />AP.BeM A—IM <br />Oe..1 I .F..II.n Br <br />A1 .-R- <br />Pub. Stealth Serv, - Eftro. 1173 It/Or I�j <br />pt CODES FEE INFO <br />AMOUNT MM11M <br />CIIECR.ICASN <br />RECIOVEE By DAIf �� <br />P97AITAfl1Y1C2 REOVE.t IIL.MBgA INVo10E <br />a <br />2 <br />I !. <br />1114 3U <br />i� <br />Pub. Stealth Serv, - Eftro. 1173 It/Or I�j <br />