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APPLICATION TOR WELL)PUMP PERMIT <br /> SAN JOAQUIN COUNTY PU9LIG HEALTH SERVIceS <br /> ENWONMENTAL HEALTH DIVISION <br /> P,O. BOX 388,304 EAST WEBER AVENUE, STOCKTON, CA bLs2 l3g0 <br /> (209) 408.;42U <br /> NOK-RIFUNUABIf PERMIT EXPIRES I YUA. 110M DATE I SJ U(p <br /> - ICImpki.In 1rlipIkeW <br /> .Fwi1CA1104 IB IIERE BY MADE TO THE FAN JOAOUIN COUNTY FOR A PERMIT TO CONAlAUCT ANDIOn INSTALL 711E woF oi6cnmiiu min AFSIIC ArION 16 MAO[IN co­­YRI N F+ <br /> AAUUIH COVNrY OEVLLOr ALM TITLE.CII P EFL 0 1116.E AND IFN 01AHDARUS OF BAN JOAQUIN COUNTY PUBLIC MERLIN AkRVICES,[Nyh1ONNENT A.I HEAL IIF FR YFP IDH <br /> JORADOREssmAAJ'n, 6<,4`I Enl ARCA D@Ro IDl2!✓ CITY S7-ocj<TOa PARCEL 9uuAnlr <br /> 7�rti P66R5 L)S 6120UN //48 RLP/N Ranh plow, S/o 0 <br /> Owr+En'A NAME 1 9 LFs n�rJ Y AoollE91 t v GR ' S/T T 45 Y i� �` L'' �'L� <br /> R0. oX 3 / g45 71 �J 5 7 707 <br /> coNTRAC IDR 'Y- DQI!-LING 1ALIC Apw1EAP RlI7 VISTfl CA LICJ BE++oN[r.x7F'1Rr,� <br /> CONS U c 7n N7" 71,3 S! OS <br /> 111.-e+YT.+ ," 1JR A!E .4 tR(�/T R AOD+uve,/iA1CPRSr IEC-h 9-3-E106 Ij r_ A. <br /> BION[.��141 <br /> 1Y F L P ❑ NFw Y+TLL V Rl� WCtmW7 WELL NONFTONNa YIELL 1 �IEICG LIIS 0 OI <br /> Q +NBEALLAIION Q WELT 6Y4TEM REPAIR F] CPOeB CONNeC1 F4PAIA 2F [JIarl, ❑ VA fl IXTMC110N WELL r <br /> 0Nw0rL9J, II.P. DEE'+H PUMP PEI EFT. 30' 7b. FIRST V1AIEA Lr Vft 0 <br /> NYF1 Elf PIIMN r—, a <br /> ❑ OVT-OJ-RCn VICE WELLE7 OTOPHY AIC AL VYELL r ❑ 6OLL eONNO <br /> 4-90 -2- _ a <br /> ISdDkgrllyarrDH� CCpRUING TD C 2 CAW 1 S�Q-!1 r_dS r /' J2+y-E o INC s <E _ <br /> S - <br /> CNI AVC I10 IPL -ICA lull <br /> IH rind[D VIE II'Y1PE OF wtLl �--�--� <br /> LJ OIEH IOTTOu DEA.OF WELL Enc AVAIION OFADFA or CONnuc IOn CAPTNO� <br /> Q IHDU RT mAL .. <br /> ❑ppME9T1CR1UV AT[ I❑—,aM VEL PA[IEIAIIE __ <br /> IYPf OF DA WNal97 EE LePYL�_ ..( OF V+IL CAA+HO <br /> ❑ry NllC eI.+UNICIPAI <br /> LJ Do VIN oEl'7II OF OROLH SEAL J_ eP[C HICAI K]N� <br /> OPOUT SEAL INSTALLED by DnOLFT DAAND <br /> ❑ IPNOArlO HIAO aDTFIER <br /> ❑ MONN ONIrO OPOVT SEAL FVMPED'0Y 0N CPHCRFrl f'lfk sl AL PY ONLLFn-QY.. ❑u. <br /> LOCKITTa CHEPIfn Bal[ll"IOVE MPe S <br /> APMOK.RVTN <br /> r+lOP01mCONIrR1ACTIOkF1Ytl1 VMO NET N00' u1rO RQIARY__NIR P,DIAnY <br /> AVOER CABLE OIIITR <br /> i FIE 4FRy C4gTIEY I IIAF I nAVS NIEPAMO I>•I9^nI (;A110N A 1 TNA1 THE yyCM y Ll AE CONC Ile ACC OPDMICF N'.I H BAN JO AOVIN COUl11V DPn1H AIK[B,S7 ATE Lh1"A.ANp PULLA Ano <br /> n[O ul.5i4U Ne or rllC RAN.FOAOVIH COUNTY, HOMF OWNER on LFCEHIFO AOC M'D IFONAIVItr.C(RIIFNI 1H(FL.0)W+Naf'1 c[Clry THAI Rl THC SUIT <br /> Oo ANCF OF i91 IYOU FC"l nijr Cl F <br /> l 101 IY nAr17 FO I..UED,I IIIALL NOT LMPLOY r PDONS AUa AC7 10 wo"WA"'ca,gL H ATION V.wc or CAHIO•rIA_' CONT RAC 1p P'B MNNO OR eVl CONT RACllNO 9FONA1 VRL Cl kTl^+fA <br /> NF1 IOLLpWINO: "I GkTIFY THAT!H TI+[fEWORAT ANCf or THE Y"O FK rOR­IGHTINS MANIrf la IIDVFO.1 All LE CMEROY FERPONR lmj JFCT 10 WORIPTAN'1 COU P{H IAnnN 1� <br /> CALIFODNFA. 1 PTJC ANI NVIT cALl]4 HOMO IN ADVANCS FOK ALL n[aF m IN*. CTIaHI AT HDI)♦Y-'4 AI. CO UPLl1E ORAYAFFa A7 LDV+TR ARL^PI,O VIUEO <br /> ' <br /> Fla. GO/�S 111, �t�O.S. 4 S 7— n.,._//-2 O- 7 - <br /> Ny�K <br /> OT PUN Id...•Fo SaN•I A.J. <br /> 4. Loc+rlpH of IwVnt pFwhDE rnnroeAL PYIT EN on rF•4 eo slD <br /> T AMEn or 91 IFACTI on FIOAO5 NFAnrtur TO on BOUNOINa THE pFb PIL Em EXPANPION or TiewAo[MRMAxl."IFTfuFT. <br /> E.a.n LI NE Of 1NE Pr,q Pfr1TY,a1VTNO 06"ENSIONe AND NO—aINCrlp lf. LOCATION Of I TLLu NRT111N M01V.of OM NV,+UIy 11111„!fl <br /> O,HENBFONED-VFLFMO ANO LOCATION Or ALL FX'UllNn ANn rl""R[p 1 0111111 n1d PErTY OR AO JOIrJIHO rnpFEn(Y_ <br /> SIAVCTVR[s,INCLVOINO COVEFQN <br /> D AREAS CH AS PAT",,OPTVRVAYI,NTD WAIATI. JJff —� <br /> 1.10 R SH I <br /> L OUR 1!Ehl"FI!LE I * rr Ff�'1 <br /> SLCYL�LI• <br /> iF''P <br /> lip-I <br /> Bull GII"1 <br /> L <br /> \l�GI ul! <br /> p r <br /> LarFvAEIOr <br /> C PIa1.lIEa <br /> 4Nc " -� <br /> a[PLR7M LNT VII ONLY ��A <br /> Pn+m.lmn AR.wIW B. — <br /> A OrF. 1'ymvl+,nsFlon PY �� _��,_+lFi• T <br /> O,o1,In.Pec llee e1�_ <br /> { ACCOVn1IH0 ONLY: AIOI EAC! 11I <br /> IFN 010 <br /> PL CODES rut INFO AMOVHI R0.1177FD C MIT ncco VEO er DAT rrFv n1lI pINC[AEOVCIr nl/Y•BETI 1 II <br /> I '� <br />