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APPLICATION FR WELLPW PERMIT <br /> *AfAN JOA COUNTY P.1)"KIKTN SERVICES <br /> INIIO1TAt NEALTN BION <br /> P 0 BOX EN, 445 N. =AN JOAMN !T.STOCKTON; CA 9Ei01. se <br /> 01) 488-MO <br /> H&MM90 PME RM I MA MR DATE OWN <br /> IOII�IEM b Tri <br /> AIMJCATION E 1mE IY.MADE TO THE SAN JDAOUIN COUNTY POR A FVMI TO CONS INICT AND/OR IIMTALL THE WONK DESCRY.THIS APPLICATION IS MADE IN COMIPUANCE WTrH SAN <br /> JDAGUIN COUNTY dEVELOPMI W TIT E.CHA"Ell 9-1115.3 AND THE STMNDMp OP SAN,p�l COUNTV MUC WEALTH 11E11VICK EM IRONIAEMu MEA4TM DIVISION. <br /> JOB ADDRE110I0H APRMI t CITY APHI,P <br /> OV**"NAME ADDNESS Pullf N �� <br /> CONTRACTOR �y ADMI;6 EIC#_PHONE A / <br /> ADDRESS "' ucm� PRONE S ---may <br /> ToPWELu m, ❑ wwWeL ❑rovemm m WELL 11 MONITORING WELL I M <br /> © MISTAuATm 13 WELL IrITEw IOPAmCROSS CQRINECT fEPA1R APOR EXTRACTION VYELI# � ,/ <br /> HYPE OF FUMPI <br /> ❑Nwr CI nw& M.P. DEPTH PUMP SET OOT FT. PWATER LFVEL <br /> ouroF.stERVIeE WELL C] owwrom WELL: 17 IDIL oomm , <br /> 17 DEnTNRCHON: <br /> A <br /> I'mmrrdAL C]OPEN MOTroM DIA.OF WELL EXCAVATION OUL OF CONDUCTOR CASING p <br /> ©ownwrAmVATE ❑GRAVEL PACK/NZE TYPE OP CAIIMOIQ[fE Aw DIA.OF WELL CASINO o <br /> C3 mKw wUNICIPAL 0 DRIVEN DEPTH OF GROUT SEAL sPECiHCAT10N e <br /> 13 IIIIATIONlAS ❑OTHER GROUT SEAL I INTALLIM ISY GOUT IRAND f <br /> ©woR "we am=SEAL P1Arom(3y. ON. CONCRETE PEDEITAL Rrr Dmmmw CJ Y. ON. s QJ <br /> APPROX LOCKIIG CHESTER DOXISTOVE PIPE s <br /> PROPOM MrtTRNDD: MUDROTARY AIR ROTARY AUGER CAMJ_O'THER O <br /> I HEIMY CEPRFY THAT I HAVE~A/ID THIS APPLICATION AND THAT THE WORK ML BE DONE W ACCORDANCE VAT"INV JDAWIN COUNTY OPPINANCES,STATE L/LWS.AND MALI AND <br /> RIEOIM.ATIONS oP THE SAN JOAOUIN COUPM HOSE OWNER OR LICwLSID A&MIll 8I M 41AM CERTO M THIN fO1L WING:9 CERTEY THAT IN THE PEPW WtANCE OF THE WORK IDR <br /> TMS PIM r No 1SSUTD6 I OWL NOT EMorIOV nimmom SuLmr To WoRRIMiIwS R:OMMIlIS UM LAWiI OF CAUPOWAA,' CON RACTORWS.o1OING OR OU CONTRACTING WONATUIE <br /> TWE PoudrAm " THAT IN THE OF THE WOLK POR WHICH THM 1!I!M a NSI P1 I SHALL RJ oUff POoon SLISJECT To MIORIOMAN'S COMAPINSA OR <br /> Mo AMVAMI PSR ALL REOIOIle .A_T WO COMPLETE ORAWING AT LOWER ATEA <br /> X TRW <br /> PLOT PLM paw W*odd I.N. [b <br /> T. HANKS OF Sn1EEI OR ROADS NEARW TO OR IORAIONI TIE PROPERTY. 4. LOCATION OF HOUSE SEWAGE ONroM SYSTEM on PROPoSED <br /> 2. ounm OF TRE PRDPERrr,OMNIS omommNS AND NORTH oIECHON. EXPArLI1DH OF IlWASE OISFDSAL SYSTTMY. <br /> S. OILLdIMONEO OUrLOEI AND LOCATION OF ALL IXMTINIS AND PROPOS® I. NACATRON OF V NUA WITHIN RADIUS OF ONE MRSUIED FIF rY Fr. <br /> if1INCTURlf DMUDING CGIMIED AMA*SUCH AN PATKNS.0111101WAVII6 AND WALKS. ON THE PNOPIM V OR ADJOIIIIO PROPERTY. <br /> ;......:......... <br /> ... <br /> ........ <br /> ....:.............:...... .. .. ............................ .. ......... <br /> ...:.. <br /> :.. <br /> ..:... . <br /> .L .... .. <br /> � .. ... .... .. : . : '��'....... : ..... ... .. ;. ......:::: : .:.. .:: � er z���ice::::. . , <br /> : : . <br /> y .. `E'IIi <br /> . fur. <br /> ... .....: <br /> . .... <br /> ..... ...... .. .. <br /> ... . . .. .. ... ... <br /> :.. ..... ... <br /> :... ..:.. ... <br /> ....;.... ............ . <br /> ..... .. .......:....................... <br /> ,.......... . p:. .. : , <br /> �_ _ �� .... :.... ......... ,...... :... .......;.... .. :...... .....Pim.. . :.. <br /> . ... _.:. <br /> l d <br /> 7ty. t •.•� _ _ <br /> 77-1 <br /> :...... .... .............'...,...:,............. ....;.......:.......}...... <br /> ......'.....,.:......:}......' .. ......:......{... ..:. ...' .. .. .. <br /> irL L''`i 1 Pi Ato <br /> .... ...... ..v.. ..:.. .. .... <br /> DEPARTMINr LSI ONLY DO. <br /> ARS AaasPtsd sf - <br /> rkv <br /> Gr.tR Irrpsads�oT D.e. R.nP amu«+or <br /> Ortluodon le�psopsn Ir o.o. <br /> C <br /> Ac�UNTMq oNlr. AIDS FACT <br /> PI ROOM 111111 111110 AMOLNIT Lrl/TTSb NIIOEVID IY DAYS 1 E 111IIIANIQE RIDYNT 111 S IIIVOICE <br /> v <br />