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't <br /> A <br /> APPLICATION FOR PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC 9MTH SERVICES <br /> ENVIRONKENTAL REALTS DIVISION <br /> 445 N SAN JOAQUIN, PHONE (209)468-3420 �N <br /> P O BOR 2009, STOCKTON, CA 95201 0,6 72b <br /> (Complete in Triplicate) <br /> Amuestion is hereblr mnde,to Baa Joaquin County for a permit to construct and/or install the from berele described. thio <br /> eoollestiom to ends is eowlianeo with San Joaquin County Ordinance go. Si9 and k and the Rul#s and Refulatlome or can <br /> Jeaga"County Public lealth aarvic", <br /> L, Jeb Address Wt 8lte,Aareap �7 <br /> ` talrrwr's Margie Phone -— <br /> CenllaCtef real a Litems#Na.Y=f F Phone a <br /> YPE 3F WELL/PUMP: f NEW WELL ❑ WELL REPLACEMENT r1 DESTRUCTION 0 Out or rs Well, LIx <br /> PUMP INSTALLATION 0 SYSTEM REPAIR C7 OTHER 0 wool""04 Kms' C] <br /> DISTANCE TO NEAREST; BEPTIE TANK , � SEWER LINES D P AL NLD. PROP. kfNE <br /> F FOUNDATION AGRICULTURE WELL ER WELL F1Tb1SUkIPS <br /> 4¢ <br /> ' <br /> INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTIONS CIfICAT10Ng <br /> C3 Wdu~ 0 Open botlofm ❑Mamnca Die of Wee Et .. DTs:of Arae Cot" <br /> ir1 Dow'swerPfi'sa L-1 GresP ee <br /> ❑Teen Type of Ca .Y� Spea t+� ` <br /> 171 Pt*k n o"w rl Dohs Owen of I or Type at <br /> 1 I W"=an _AP".Depth I I Eaaw" VON* +sed br <br /> ADO&War Dans 0 twos M rum,- N.P. Stn wart Dorflt_ <br /> r1�hN DWoutdom 0 Woe DWPIW a assund ttawrtal & Depth <br /> DsPhh Filler watarial Depth _ - <br /> r. <br /> OF SIPIDC <br /> WORK: NEW INSTALLATION I I REPAI1yADDITFON W DESTRUCTION 1 I h+i M Outdie www Is <br /> ,// aveitebla within!00 hseJ ` <br /> I' <br /> sketaftden ww Mw:IR W 0-=-COmnwdM r..... 01Mr —•• <br /> y <br /> A w"N Being WaL. fNom*0 Nif be0100Rr <br /> Ckpo sr M ell aa depth of!fatly 00th <br /> depth <br /> "vy1�t0.TMATMENT PLT.DMd of bilparM 8 <br /> 1 <br /> DMmes It <br /> f a s e.i�A�'IISIO LNC O Ne.g Lamgth of when WWhlNn <br /> " q" r�LTiR gW D O wneo to nomem WellawtWMam P+owny Liao ' <br /> fir`^ tit <br /> rti - <br /> f dun <br /> �77��** ;AiiIEPA <br /> M. DWlhea M : WM fAAIundNbn F+iepsAF LkN a <br /> Y° €r y POND! 0 ' <br /> 'I koft W" I Nes praoefed Ids opprcepen w d Ow We waft anti be dens In ecco"bnw with Sam Jo"Uhm eeufMY gird Often.MaM leder WA <br /> a rgr. t SRlwe'Md legrfetsfhe of the Ran JO&pA%Oellft <br /> r, Puf <br /> A <br /> ;ewM arlllsf fA lEs+fesd ogefM s eM+eluw aulilNe the tallowrng;"N e+ftllY Mae In!ttls paAalmorfoa M Iles wok wN/nleh nis N1 is iswrd.Yi no <br /> etlee <br /> ' ` ,Iwteutl NMfI►peRreR luelh atnnlw <br /> as t o 6101111101etlbieet to"00110010%maw eefbm taws of Caefenhio."Colttroetals NYiI+g a flub eenaAeHnO elprtethe"e= , <br /> . *- jNhlflNess UIp Nef.mt w.."I wft Inst In ow wls" "of the weft fa*me%Oft ba is lamed,l&M iwv a vafaoms subset to waUnem'a"WWW46- <br /> k t3TM dpokwo l..� I#r aft w..P�w drrwr+g aR le.erN dde. �y1 +`�. <br /> r ILS a Dofs <br /> ' rl► INT Us&ONLV <br /> r ^Aaeeotsd MAA <br /> !. _.Am- <br /> Ir <br /> L.►' OfM1A itMlaetlo+n by FMM bnpaotlsm by - <br /> - i <br /> a/nldllten2l CORs/rr+ts: - <br /> kl Appllcast - voters all cops" toi nam Joaquin County Pubtie Wealth Services <br /> y reeiroamsntal Realth Permit/aerrieea <br /> Ne v a" Jot►auta. P s 20". state. CA 95201 s2 CdD�3 <br /> i <br /> I ASA XW ow AMOUNT REMITTED REC W OATf "ItawI'tN0 " <br /> � <br /> �� Zzz <br /> aays�aw r..e� .� <br /> a+ss <br />