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APPLICATION FOR VIELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,304 EAST WEBER AVENUE,STOCKTON,CA 95201588 <br /> (209)4883420 <br /> NONBEFUNOANLE PERMIT EEPMEN 1 YEAR FROM NATE INSUEN <br /> ToFmisN N TIIIRiEtFI <br /> M ATN)N N HERE! MAOF TO THE W1 MAONN=O MR A FERMI[TO CONSTRUCT AHOPOR MBTALL THE MAR W11CR«O.TMB NRELATMIN If 1MR M IMRNMtf WRN FAN <br /> MAQIN COVNry OE OFIFENTm1E.CNAVTFF0111 S.3 Ab THE BT.VAINN Of RAN. AOIAN COIMTYW IRALTE ffM .LNN110gAfMK NFMTN 11Mfp1. <br /> AS AVORERFTR AFN[���5 �. NW�� �� Lr,�TY SLt'ec.\l!ecN MIC RTEEIANE <br /> owER-E NAM <br /> 1 <br /> cONIMCT01, l]1�1�y 2C1P\ tl<"\� Ad]11F«\\3ay\�1. DceWLLlw\I IC. fEpllEl��l-l�l <br /> BVRLONTRACTOR ADOIR« IILB PRONE. <br /> rYR OF wV,wIA[' ❑NEw N(u E0 xvL.cEMfNr weu ❑MONnoIEND MHl• ❑orwk <br /> �ZI NETALLATNx ❑N tERMmm W.. ❑Cb«CpR1�E'C�TE�WAIR Q VMMFIf1MCTMIN WNLI J <br /> CUt ®WAOFRRAr NB.�y� pETXg NB EEIy . flRR WAG EV6 Le�� O <br /> RYIF Oi N1MB1 �` <br /> ❑OIR#BEMIC6 W[LL ❑OEONNRCK W[LL I Q RM bM1b <br /> ❑OEBTRVCTNN: <br /> N VIS® ♦ VCTION EIEC r A <br /> SAMIRTNAL vomm WO w MA.OF WELL EECAVATVM OM.OF t,HAXX,ORCABNp D <br /> OOMEFTN, V.TE 13 RAAE fnf E TYROFCANNI)MEV ELEL dA.OFWf A. 0 <br /> ❑RIMICAIVMCIOAI ❑DENT. DfRX OE OdMIT BFAI FPEC,`RATVN AJ <br /> ❑IMOATIO. ❑OTHER OIfIVT FRAC UNIT.EY OR]IR EFARO. E E� <br /> ❑NOMroNNe aRour REAL Fw O:OYr ❑a coHCRTtrmEnAL Rv oM1UER:Or� ❑N 9 A <br /> AFFbN.oVIM JOI LOL%NG CMERq bx/ROVI Rf[ 3 <br /> FROF MMINTVILTWNANFWNO METHOD MUD ROTARF AIR MTARY AVSEII "Kf OTMER U <br /> 1 REN CEIVM THAT I HAVE MHA TME A.TR'ATION AND THAT THE WORL MALL DONE N ACCOROMKE WRIT FAIT MAIX N1 COVNTYOgNNIC«.RATE LAWE..ENO W1EE <br /> REO%KAm«Of THE EW <br /> AH"AM COUNTY.NOME(RARER OR L]CENMD MEMF <br /> 'F VNATVE CERINE <br /> RF THE FOLLCMM MVH[N:'I CERTIFY THAT THE RIEdMMICF OF THE PoR VIIFC <br /> TME PW4T V RT.FO.I ENN11gi p0.0Y FfNd1F fEIF.ILR TO W0119AAN'F COMPpEAiNN IAWB OFCAMfO1MA•CONTIIIOTOR'F IMO OR FIIFCOMMCTMO FNNMNRE C[RII`IF$ <br /> Tlt fOEFAA'H.I: '1 CCRTIFY TXAT N THE Ri10M1ANCf OF TMF NLRf f011 wIKN TME RRMR IF IEFU(O.1 ENALL fMROY R ORA FW[CT TO NN FIA RR COENEFIFAIMIM IAYA Oi <br /> C/11IOlYE/I�A,['�TNE AfAfN�I"N1I YM\\WTCALL EA NOIN IN ADIANCF FO\II ALL 110NF 1T 1[IMIAMJEiLE�. �COMEETF d4EVMO AT IOIM I;RA fEtlNofO.0 I � <br /> EIV;,[)!\ ` \ \ ` `� \ TA TNh <br /> �` 1 <br /> ROT Mx"A"H—N EAW� <br /> 1,NAM II OF RTINETR OR MAOR NEARER TO OR Fd1N..THE PRONRY. A. VICAT9M OF NpVBE FEWME O EEV m FYREM OR F ,OFF, <br /> [.gITVrE Of 1NF FMIFMY,OINNO OIMfNBgMR AMp MR[H OIIECTION. E%FMT.OF FfWAO[dY. AYRIEME. <br /> ]. TRRKN AES. UOINF.LMLOCATN)NOf ML AS PATIOS, <br /> RgMFLO A.LN THERHIOEN,Yo VATHIN..KIONE MINORO FlFTY R. <br /> ETRIKTVRR.NCLVdIp LOYTRFD ARFJd BUCN M FATIOB.ORVEWAYB,/JID W.W(B. ON THE AW Rgry OR AOMIMxV RORRfY, <br /> _. <br /> � � G U J7 YV <br /> �eme�il� <br /> PAYNAEN3. n/ <br /> MAR 19 1996 <br /> PUoLIC HEALTH 5 PVICE `A <br /> cNJ PGIVMtNTALlTEALh,., , ,,,,, C�NIy <br /> FRFNC� C�n\� 1 � 'cam <br /> peFMrTUENT VFE ox[r �[ IF- (� <br /> A..II..w.Awglal Fr / ^ /1 I I 9 ^+ w� <br /> 0. <br /> 11 1 <br /> O.mn l;.[sehn RF o.hair <br /> .U6.(A.[/ ""TMA ] <br /> p�N.RE...m..erl„Br au <br /> c.m <br /> ACCOUIITNO oMY: MOF <br /> RCO. REMTTEO NW FMN RRVVEDFY DME TERMTMVIWOE—T N— —1 <br /> 3 O vC`i' R 9d <br /> g'13� <br />