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f <br /> APPLICATION FOR WELL/PUMP PERMITE L L <br /> U.- <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVIr rENVIRONMENTAL HEALTH DIVISION <br /> V,rr304 EAST WEBER AVENUE,STOCKTON,CA 952.02 <br /> (209)468.3420 <br /> RO141011IRRBIE PnXIT_MRE3 1 YEAR FROM DATE 138RIB <br /> AaIIFIELI Is TlbRnu) ' <br /> APPLICATION 18 IIERE BY MAOE TO THE BAH JOAOUM COUNTY FON A PERMIT TO CONSTRICT ANMR DIITNA INE WOIK DEICMM.TRIO APPLICATION M LEADS IN COMPLIANCE Wrilt BAN <br /> JOAOM COUNTY DEVEEOFIAENP TITLE.CNAPrEH i-11 5 3 AAM TM IM /SAN JOAOU7N COU M[IC HEALTH KRVICED.EN%W NMENTAL HEALTH DFVM1*�N.. <br /> .10E Al1OlEGADR wall A.A.R�PeZ CRY ►ARCIL SIEF/APIMA 1 -i W i <br /> OWMR0.•E IAALOE /400IlEEE ry ]{1'- [y t' PHONE I <br /> CONTRACTOR ADONEE 077�;t N if Xb uea /PRONE/ <br /> BVE CONTRACTOR__... .•�ADISEIS Uck - PHONE A <br />� r <br /> rm OP wtw"wh 0 NEwwGEL C3 Nr L.7 <br /> mmmEmEvmL mmmo m WELL P Q OTH[II_ <br /> ©DwAuATON E3mu sYsTEM REPAIE 13ROELCo1IEC <br /> CT IMPAIR {�VAFON E%TRACTww WELL I <br /> ❑11wh=I RE►aV NA. <br /> RrPE w PUMPI DErrN PLEC <br /> REP T rt, FIRST WATER LEVEL D <br />' <br /> OUTOFfERVICE WELL If C]GEORIYEICALWELL 0 D SamsoRNG B <br /> JqF OESTRIICTION: <br /> M-TQIDED USE ►E uC X A <br /> ❑HIMMwA& ❑ EN OPBOTTOM OLA.OF WELL"CAVATTON DUL OF CONDUCTOR CAMMO O <br /> 11DOLIEETICAwEVATE E3OMVEL PACxmzE TYLE Of CAE NMf2TFrLWV. DIA.Of WELL CAEIIM7 D <br /> ❑RwtICAMWHICE'AL 13mmN DEPTH OF GUM MILL sPENr"TRN A <br /> 0 MWAIONMO ❑OTHLR GROUT IEKSRfALEEtp BY OPOYT BRAND NAME E <br /> ❑LLD/Irowlw OIOIJT ZEAL PummD:Dv- Elm. cONCRETE PEDESTAL w ORUER I7 V- ❑N. a <br /> APMWX.DEPTH LOOKING CNEITER soxmaw wPE a <br /> PROPOSED CONETRWTIGNADwl1AEO METIOM MUO ROTARV MR ROTARY AVOER CABLE OTHER__ -- <br /> I NE4:Ev CERTIFY THAT I HAVE PREPARED THIS APPLPCATRN ANO THAT THE Wows WALL BE DONE M AMCFOMICE WITH IAN JOAOUM COUNTY o1nmANCEs,ITATR LAWIS,AND Rx.Es AND <br /> IWOULATIONe OF THE GAN JOACUM COUNTY.NOME OWNER OR UGTNEW AOOEr'S EwNATUFE CENT FRO TNT FOLLOWTIq:'I CERTIFY 114AT IN THE POWIM AM10E OF THE WORK FOR WIRER <br /> THIS PERMIT IF ISSUED,I SHALL NOT EMPLOY PWOONI SUB.MT TO WORAMAIFS COMPINSSTON LAWS OF CALIFORNIA.-COHTFACfORV WNOID DN W*4;VRTFV=M SRNATURE c[RtWMs <br /> THE FOLLOWWNG: •I CERTvv THAT FI TII PERPORLOANCE OF THE VANK FOR WHICH TMe PUWRT w ISSUED.1 SHALL EMPLOY PERSONS @UGJECT TO WORIMAR'S COMPCMATION LAWw OF <br /> CAIIFOWRA' wA R M CALL 34 HOURS BE ADVANOS ROTI ALL IRGISRED MEPIC `S AT ra"Sp44fa.COMPLETE ORAWRa AT LOWER AREA PROVICEO. +` /'T <br /> 91rWx - TIE. +/E wu _ja—a —VD. <br /> PLOT PLAIT Loran 11 a."Ler. •M <br /> 1.HALOES OF STREITE OR ROADS NEAREST TO OR BOUNDING TME PRI)rDwy. 4.LOCATOR OF HOUSE SEWAGE oa/OSAL SYSTEM OR PRDTVSEO <br /> !.OUTUNt OF THE PROPERTY.GIVIa DIMENSION@ MA NORM IIIECTION. tXPANSWR OF SEWAGE DIIPOIAL SYSME. <br /> a.OBA[REONEO OUTLOW6 AND LOCATION OF ALL MOTMI IVIG IIIGroam E.LOCATION OF WEE"WITHIN RAW=of ONE NUNdlfO FIFTY FT. <br /> ITRVcrU ES.RC'LtIDO G COVOso AM"SUCIL AB PATIOS.DRVEWAVY,AND WALKS. ON THE PFKlftRIY OR ADXRHINS PROMTY. <br /> :.:.. i... > . <br /> a , <br /> t l <br /> :. .. <br /> YMEN7 .. <br /> REQEfVEC <br /> �. <br /> �m �C 2 Y 20Q0 <br /> V � A �1*�[i}.�0.-{ 4 91 + YAH SERI 01V [C� . <br /> P <br /> AN JOAO <br /> PU�LlC HEAL <br /> aw+ENTaL HEA <br /> . .. ..... .. . : . <br /> p1WE <br /> O MIEIFIIT YSI aNlr <br /> AFPEaati..AaaaPeal er L6 6 <br /> ' Or.w W"."r tN DAtS nary Mr1E.aSan BY Date <br /> iO.mu.a....►..ww er Dae. +�� <br /> G <br /> I - <br /> ACCOVIITMO ONLTf AOS FACE <br /> M COvu FIX MFo AAOUIIf=111D CHECRS IyN RECISIM ST OA P9RBTIE OUpT NT INVOfcI <br /> toy-:- <br /> SEW "In <br /> o acs <br />