Laserfiche WebLink
APPLICATION FOR W,,LIPUMP PERMIT <br /> • SAN JOAQUIN COUNTY PUBLIC HEALTH SER�S <br /> IWOM ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE SToCH; R CA <br /> (209) 46"20 rd P14=F' <br /> NOIFREFUNORBLE ?ENVY <br /> A CATTON"'"M RY MADE TO THE GAN AW.OUIN COIRTY"A F T TOCb I <br /> JDApRN COUItt i OEVEIAFfMEM TRLE,CEEA/Tp1 9_1 11 S.J ANO THE i ANDA OF EAN"AMM COUNTY pU14ALTX WRVIC[$ <br /> OUC DEOGI�LO.TIIIG APRlCAIION 16 M.DE IN COMFLJANCE WTH <br /> P SU <br /> AOE AODRI .PN. 310 32 D vC..OL / _ C ENVIiY]NMFM!L MFALTH mnIpoN. <br /> � CITY JTaUL'f?h1 <br /> Q%VI ENMEE_I`�^� Y/ CiI.L-A(F.". M� fA�EE2U.rwr <br /> coT+TR.cYDR Fhjf-FA-ZA-tar `]�ILIt.�,wNG A' " S:k-mE <br /> ADOFFn SzEuI <br /> BU,GONTMCTOE • 1E ls�.c FHONEf Slo- 9 '-��: <br /> ADO" <br /> PIRG w. <br /> OPE D HEW WFu ° FERAGEM[XT WF31 13 MOWT w ° <br /> YV[1j, p�N�p <br /> D METAWTXXI [3Wt.L 4T£IEM 1fDAM lJ GADEBZpNERCT R®MI `^----- <br /> ❑ VAPOR tXTRA4MON WELL E J <br /> ❑Nwv R�E/E' N.I. DE9TX RMIV BET_R, <br /> TTvn OF PIAVI RPET WATER uvm O <br /> ❑ OUTCF.EExvICF WELL ❑ OFDFHYs ut wm 011-wk ROINNO Z - zU G4' <br /> ❑DEETRVCTUH; B <br /> rHTwOm Ilf( TTEE Of wEu cyNSTRUCTIOX EPECTc.Tip <br /> ❑ XtpFTE'TNµ ❑OPEN EOTYOM DLI OF WELL EXCAVAT A <br /> D ODMEETIClFWVAT[ 0GAAVE1F OFA.OF COXdKTTOR C,,,NO <br /> ° E Mn"UEIICIpAL 0 DWA. AC>;IeQf oEpE OF CAwLrT SEALM/c OLA.OF WELL CAW D <br /> DETTM OG ONUVi 1AK ��� <br /> ❑ O000A70NIAQ °OTHR G MrMATION R <br /> OPDUT TRAL EE6'TAl1IID wOROVT ERANO RAMS <br /> ❑ uOM(Olepc ORDUr e¢a FUEIroFn: D... �H. coNGl¢TF FEDEerAI n DRIUFJI Y.QNo s <br /> AFMO)1(,DATX <br /> IDOVIO Cl1EETp{EOzIBTOVE PF< <br /> '"RO"OM COXtTRUCTIDX(DIEFyINO M 17: MUD ROTARYB <br /> AIR KYFAM .L C u OTIFEA <br /> I HEFFBT CERilf1'THAT I HAVE PF.ID O T1M AFfFICATON ANO TNA,THE W'vrK.,L EF PONE EI :11; WTTH BAN,pApyE1 COVEEIY <br /> FFGIAATTON/OF THE EAN JOADURI HOME O'ATIER OR MwImEO AOEM'E EFOWTFIRF C4RTIFOi THEM Of�ANCEB.STATE UWi.ANO V.AND <br /> THI6 pERFETi IE 188I/ED.I OIAll AOT PEAWEIt GUB)ECT UDNTN6: Y CERTIFY TWT W THE FFRFOIWANGE Of THF WORK FOR wNICN <br /> WOIY0.FAX't COYYpy}yy UW60F G.U]POPNk' CANipACNR'BMtarq OR EV}OOETTRALTfHO EgNATVRE CERMIE6 <br /> TNF iOLLOWNq: 'I C THAT <br /> M pERfOIOE.A'�'E vF 4 WON(TOR`s IMIN EEN.IY A <br /> CAIfPObeA,' 1'VCART FRT U NOVO oT AOVA C FOR ALLTEMFD.I BNA[L ENFLW F90JElE EV6RZT TO wpW.AHy COM "mm LAWS OF <br /> R➢l1Vm M/ROTIOEE/AT COEI•6-EAiE. COEEiE);1E FENdIAWINO AT lOwbt AREA NIO VIOFO. <br /> 1. NMIE/OF 6TRIITE OR <br /> MOT FLAN �v to BeHJ YwH y <br /> MADE I+O LW TO OR AND 10OR THEM I N, E. FOCATION OF NOUS(EEWAOE Ot VAL grg OR pROMM <br /> S. Ot N Of TNF PROP Il AN LOCA LUN OF O AND WITH Df�TTDN. <br /> ]. OIMFNBgNEp OVM1F%AND LOCATION OF ALL FAAT000 ANO ENOL'OED) EAP1UfBION Of EEWAOE GEEM¢AL EYETEMt. <br /> iTR11GTUFEE,MC{11DINO COVERED AFFAB SUCH Ae FATTOE,MWWAYS.AEE)WAS` E. LOCATION OF WELL,,WTNGN fA01U/OF ONE VNOI�V RFTY R. <br /> ON TTfE RmFERTY OR Ab"IRINO PPOPQfry. <br /> MAP ON BACK <br /> i <br /> r `ice\ 0 ARTFEOR FOE ONLY AFPUENtv.�AEOFf1ad ev 1 ,\Nt.a..,.!'.��- 13 . <br /> AF« <br /> Orev1 NEEHfHEn eT bAu PtAnr��� <br /> D.F. <br /> DenncEen My.eEew EY . <br /> OwA <br /> ACCGVTINO ONLY: ARW FAn <br /> n com FEE Nwa YJOUNT RtEMTTED cNFCYJICAaN RCYVED EY <br /> oATF F9wOTnERNC[RmV66T NVNy1 INVOICE <br /> � <br />