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APPLICATION FOR WELLIPUMP PERMIT <br /> _ SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> r^ P.O.BOX SBH,304 EAST WEBER AVENUE,STOCMN,CA 95201389 <br /> 12091 4603420 <br /> NOR REFURDARLE PERMIT EXPIRES 1 YEAR FROM BATE 14RUER <br /> pe,bu Y TEYBnb) %NORK _IN <br /> A,,m'T CON To m DE 8R AD 10-1/.JQy�JOAAPTFBNC OU`HJ/.ND THE��TTo CONBF Of 8µAA0UN lAVAa VNTY TN CHm NMpR .G.FAMAOAMFNFAI H TNM FMA.µCE KTfH aAN <br /> Joe ADDAFRRNII APNI -377tS Z. ./TIY�!J't/ 99 CR' /5 PARca mJA <br /> 2 rw [J <br /> - 3Q5z s �_...A Y6S <br /> owNER+NAIAE • y�J� AooaE66 F( L �Lj L��, <br /> [ONTMGTM //C �.Q//�1/EL�IC �G ATANAT. <br /> BIIe CDMMCFM Q{ ADOREei -S .9.!/ —C2r <br /> WFLEMI �a.R NfW WELL ❑RLRACFMEM M4E1 ❑MONROM..NTLI I 13 DYNE. <br /> ❑weTAL1AnDM ❑WEIA FT.-M—A 0 CIO....AFCT RF➢NN ❑VAMR EXTM .W 0 a <br /> mFTHPJMP6LT FT. FART WATER IEVFL O <br /> flltl�� I�NwrO PTF(, H.v.� <br /> RVM OF FVMR ❑OVTVFPFPVICE WEIl <br /> 0OEORlI61LµWELLA ❑ E04 tDIrNO B <br /> ❑OEPTMICTON: J <br /> X CFOLO DEE r Fu rtA wx aPLi cAnaME LE -- A"`Lj <br /> �wpllElgAl 1❑��pRN eOROM p1A.Of WELL 1..CAVATpN /Z MA.OFCONACTORCAANO O� <br /> XWWVT.0 VAR �ry OMKL PAC4AOE TYPE OF CAWNO/BTEElRYn �� MA.OF C. <br /> iFF4CIFICATAN ��/(�� ^' <br /> 1]g1elICRAl1MCiµ ❑ORMN OEPfNOfOMVF 6Fµ <br /> ❑IPAOATWWAO ❑OTNEA OAJMBFM wRTAIIFD Rr � I CfCiOVI tMEA NAME VZ/IA1 F� <br /> ❑ YOHI OFF, !J/./yE//. A 1 <br /> OIOVT AFµ0.M14O'OVO ON. CONCPETE{4DF6Tµ6Y drLLEA:OY <br /> AFFf1P2.OVfN (49 E-T� LOLAPp CNEREP AOLAIO`+4 Hf4 ^ <br /> moo CO1MTAD,CnOM/MEWNO MaTROO:MIA NOTARY _A? AIA MTAM AUMA EAML OIXEII <br /> E NERAY<FPTIFV TMT 1 NAN TFDAIEO TMM IRTICATON ANp THAT TXF NORL YNLL <br /> K.. w ACCOPOANCE WITH FAN AAOMN COVNTY ORMNANAT.,FTATE FAWA.ANO INIFO ANO <br /> PFaUA OFTHEBAN"AWIN COUNTY,FOMFONMEA OA EOEM6EO AOFM'F tlpNAMAt CfAfMEGTMEFOLLOWMO:'I CFATIFY TXATMTNF KAFOIMMCEOF nlF NOIR FOR WHICH <br /> TNR RA1R 1A IRRIIFO1 WALL NOT FM0.0Y RAAONB AUAJfCT TO WMIWAM'E COMPpFAOOX LAWA OF Gµ1FOMJ..'CONTMCFOP'A MNNO OP 0 VOtOMMf:TINO AIONANIF CEATRiFA <br /> TXE iOLLOWINO- I C THAT I WAANCE OF TME VAR[fOA W11KH TNIF FTM11i I81T ITRRI I MALL flA0.0T UEe AA WRRCT TO WOAMM=COMF91aAlO WA OF <br /> 1.1 M D11A�T M� V/AXCf FM ALL IIEOU11d MEF4C AT 1]p1.0i,\F/E�l.EOM0.ETE M1/NANO AT LOWED ARFA{M <br /> Ax,�1X 3^ TltlN9� <br /> ROT MN AR—1. RUIER� <br /> 1.NAMEF OF ROERE OA MADA NEAMAT TO OR w NOMO TNF A OITRTY. E.LOCATION Of MOVAF 6FWAOE C1APoAµtYATFM ON AIOIO6E0 <br /> 1.OIITI,MF OF TNF ITORRTY.OMNO..,AMR.ANO NOATN MRFCTION. ERA.W BON OF IMA.1..IDAµRVATEMR. <br /> J.ORlMAOMED O VTIIIFAµ1O LOCATOR Of ALL T."'NR ANO A`ORM E0 f.IOCATON Oi W 1.WIININ MWDR OF ONE FAT"FIFTY <br /> ..T...ACLMNA COVfAFO AREAS RUCN Al PATOA,DPNfWAT.,AND WALK.. N n1E ROTE Ofl AOJOININO RUfFRFY. <br /> U x <br /> PA <br /> !v <br /> k .V R!C EtFF' . <br /> ° Y APR 24196 <br /> X 10AC <br /> TA,llcALTH orvisloti <br /> 7�^3 <br /> O,wn lnp ,len uV✓;F ✓L/ OFu W/ F—,InPrRmITDER <br /> O�,vlbn I�pe,1+r,Pv O.1• <br /> AccoD `Aka aXL(Y�..y� /JOF iACF <br /> PL GOOF( IOOFIEY (MOUNT A[W Tifp <NFC MAEM AEGBVFD AT MfE TIE FM INVOOF <br />