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1 APPLICATION FOR WELUFUMP PERMIT <br /> SAO JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMEIITAL HEALTH DIVISION <br /> P.O,BOX 388,$04 EAST WEBER AVENUE,STOCK M CA 95201.988 <br /> 120 489.3420 c <br /> a. „'e �aaa•rsucciAgE Pt§IAIT 8 A f vul F sO14 OMTE ISSUED <br /> uDFrplPu IN rrgSc.lE1 <br /> APPUCA31ON Mt"DRE N A&M TO THE VAN JOAOM COUNTY FOR R F%M^l 70 CO"I INICI ANDPON I NCIALL INC WOHL MOC100E0.71113 A"MAT10N t3 MADE lx COwJANCT vMI1 DAN <br /> . JOAOVSI CO NTY DMIROPWIM TrTM CNArt R 11-1115.3 AND rile ETA0jgpM OF MAN JOAOVM COUMY PVEUC rLTN DEFACED,EIP1111DMULMAL MAkTN MRNN <br /> D . <br /> Jam ADOIDRSOR Y Ire T 1'AICEI DI2UAMF� <br /> OWNfItY KOM ATOM.S <br /> CON711ACTOo AIIMNRS FNp1EI��7�\W-JC <br /> DVD EONTMCTOpl- AMIISSS LCI PHOW P <br /> TYP&of watMN-n ;e wnL E7 mnAcEMEM wnt ❑MONnoNNO v4mF Q a7NER <br /> E�3 N/�j.A..L.UT071 ❑WELL DVDI WrP�IR7� ElD+C <br /> CRODONNICT WAIN (3PO <br /> vAR exmAcibNell.Wx J <br /> A "! MPFNFNMPEEI�R. IMF wATNI LEVFL O <br /> �ITYf[of Pum" �7 O y <br /> ❑Owor KN <br /> oCE WELL E3 AEL»TIYNCN HELLS E3 DOR Por" • <br /> ❑PwtRR1AC7gM: <br /> 1T DTI R A <br /> 1..P gpUOTMAI 00 ROM INA.Of WELL OCAVAIION DIA.Of CO"MXTOR CA@fM <br /> • ❑DOMEET cowvATE QOMVLR fAcatmiE. TYR OP CAAWUIIITFEL'"C OTA.OF LWLL CASMIO 0 <br /> N EJ bhV[N OMIN OF OROVT SEAL F14CFICA"Off R <br /> SSPOAlX MA0 DOTHM OROLR MAL ffWAUTO Of o1bVT SRAfID NAME 1/1✓I i✓ E <br /> 13 wwwryAq ' O+Oul STAI FVW LO:0Y— M*.-- CommeIr FeOEnu E <br /> EVORALU E l"— <br /> . <br /> APPROX.DOTH ,� __-- IOCTMAT cilED7fNl DOXMOVE rM e - <br /> SIIOPOStO COINIMCTWXMM IAM*Y2TND0:MUD IIDTAIIY All!oDtANV AVOOI ^CABLE O7MR . <br /> I MRPIIy CERTFY THAI 1 NAVE NCPAR[D TNN AMMATKM ALIO tNAT 7M VJDNI VML PE OI)M M ACCOIOANCE VATN DNI JOAMM CoUNFY ONANAMMIL DTATE IAVW.AND MRAD AND <br /> Wo"TONS Of TM DAN JOAGUM COIRRY.NOW OPRRM OR LICENE®A3N7 <br /> E 'S MOMATUM CERT RES lIN I OLLOWOIV r'N CERTIFY THAT MTM 09WOMIMANCE Of THE WORK PM VWW14 <br /> TM M Mt N*Mtb,I9MALL NOT EMMOY FFFIORII OURIECT 70 WDWMAN9 COMRNNAr"'LAWS OF CMJFOPIIIA.•COIOPACTOR'S WRINO OA 119,CO1RMM YSIM PIONATVR!CEMIFIES <br /> The POLLOPNDNI'I CENTIVY THAT 100 TR R ANC1 OF THE VTOIN FOD WDIICN TWA PERAITf l3 IvLMD.1 WNL IIDSOY PERSONS SUokNCf TO WORgAMr3 COMfOMwN011 LAWS OP <br /> CALDORMA.' TM eANf M1137 CALL •A LANCE!011 NL weDMRro 1 /S ATM DI 400,20!11.CONPLEIE ONAVA IG AT LOWMl MDA IMPOVI ED. ? ' <br /> 1 <br /> wk."K ikN! rJ9�)lJJM -D•T• 1 <br /> fT.OT RANO Ix IbWl S..1. 'N <br /> I."Auto 00 DND[TF OR"DAD*MAMST 10 DR WISftIDID FFD R LOCATION OI HOVSE fEWASE OMgDAL DYR[M OR Pf1D10Dro <br /> 2.Olrru%M Of TID FROM".arym OYDNDOIND AMD NOOTH almel qN. UVANPOM OF"WA01 019fOSAL SYSTEMS. <br /> !.awrom POII®ounw ED MIO LOCATION OF ALL tMVTIM AND 0001,01110L LOCATION 0I YNli3 t01F/1I/www"or ONE MNNOIDD FIFTY FT. <br /> STHUCtVMD,f1CLuWM COVMM APOAD OVCN/Al MUM DRIVEWAYS,AND WALKS. ON THE f MOMINVY OR ADJOPNFM PPMMMY. <br /> 1 <br /> v4q�+J-�". Z <br /> L1l.1 Y, 3 1396 <br /> PFPARTMeNT W <br /> • AryMMIrI A.wPI«Sy <br /> OwA1•xPleMw•D0 bl`l_ r,w.PxF Ay <br /> Ow. <br /> ACCOVRTMO*Poky: ATOP FAC4 <br /> Pf CPOSS PEE two AMOUNT FAMITTP CIIECk ALN MECDvwvv DAZE INVOICE <br /> �yg'f ra z.3I4 D3�Srl•r <br /> a$ <br /> Puy,41u1DI SSrv.•Eitviro.173 131961 <br />