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LL/PUMP PERMIT <br /> SAN JOAQUU COUNTY PUBLIC HEALTH SERVICES EN ONIAENTAL HEALTH DIVISION <br /> 3N E.WEBER AVE.. STOCKTON CA 95202 (2041368-3420 <br /> LNON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IOB A.DDP.ESS i <br /> CITY fLII' <br /> IL <br /> TI9r�SII9¢ncfJ� PPHxOoNNE <br /> -7cenDRE <br /> SS��OJ. 0'7—r/7� <br /> CIOR� 1 <br /> CONTRA <br /> CITY= ? o <br /> GOGR <br /> (/ <br /> X Y_TOWNSEDP_ RANGE_SEC=ION <br /> TYPEOFWELL: ❑ NEWWELL Cl REPLACEMENTWELL ❑ MONITORING WELL# ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAlR ❑CROSS-CONNECT REPA R ❑V APOA EXTRACTION WELL# <br /> TYPE OF PUMP: ❑ NEW 13 REPAIR H.P. DEPTH PUMP SEI FT. FIRST WATER LEVEL <br /> ❑OUT-0F-SERVICE WELL NGHOTECEUICAL# Z E ❑DESTRUCTION: <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL [I OPEN BOTTOM WELLEXCAVAT[ONDIA_ CONDUCTORCASINGDIA_ <br /> ❑DOMESTIC PRIVATE ❑GRAVEL PACMUE_ WELL ,ASUGTYFE WELLCASUGDIA <br /> ❑PUBDCRAUMCIPAL ❑DRIVEN GROUT SEAL DEPTH .D SP CIFICAT1 N J� <br /> ❑HUUGATION/AG 24 HR N:.�TI0L OTHERGROUTBRANDNAME <br /> R EQU ESTE ID GROUT SEAL PUMPED: ❑YES ❑NO <br /> 6. ❑MONITOAUG FOR I\LL <br /> ❑CHRISTY BOX ❑STOVE PIA N S RiECT I IDN _ ' CONCRBTEPEDFSTALHYDRRLER: DYES ONO <br /> APPROXIMATE TEII DEPRi Q7u I U T"] DJ'L� Yo F ' 1 <br /> PROPOSEDCONSTRUCT[ONMRILINGMETHOD:MUD ROTARY_ATR ROTARY AUGER V CABLE_OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDIANCES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED <br /> TITLE: <br /> V <br /> � I <br /> I L <br /> L <br /> I <br /> (1 DEPARTNTENT USE ONLY <br /> APPBezuon AmeFina By <br /> ZI 'bCo`�� <br /> Grout Lvspxtlav By <br /> sm N.P1»P EIVED Dom <br /> Idccwcuon Inspe von By "20o <br /> n Dem <br /> COhLMENTS: <br /> SANJOAGL'_ <br /> > <br /> ..."HERUH SERI <br /> _ ENV1 <br /> PE SC AMOUNT =HEC RECEIVED DATE PERMTC/SERVIff REQUEST# WELL 80# <br /> V CODES UFO REFU=TED SH HY <br /> i <br />