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L <br /> L <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> L (209)468-3420 <br /> RUN-REFUNDADLI PERMIT EXPIRES 1 TERM INDIA GATE ISSUED <br /> IGg4Y M TI`RNI.1 <br /> A�ATHN IQ ER <br /> YATO IHl .W IJOANN <br /> IN COIEV ENI A N1MIl TO CONETINCT AHOMM M AHN NONO[ICNCN THE E NM TIDE AIgATIDM AUOf NCOIM 4IAMHW <br /> AAMAH COVNIVRYTENMI TTNF{cHMF.0-1115.3 AI.O IM... .OE AAM AAOUT Nc.UMV MANIAC IEµTX E91NC!l.lNM101NlMN HGLM CM[bM. <br /> t ,�E I, EENRI,EEI, 3401 Whiskey Slough Em, Holt EAI�Q.YN.NEE <br /> 1` DwMN.NAY[ WHISKEY SLOUGH HARBOR AODE.. P.O. Box.107, Holt, 95234 NINEA 942-4588 <br /> DDMXACTq NOACK W/O 19792 AaDle.. 4500 E Fremont UO 504513 ,,,DR, 948-881; <br /> �ItOCKZon 95zio <br /> 6U COMNG,M ADOIIY EIR <br /> lx.eerM <br /> IETM ❑N[MNN. 13RNADQlX1 wNE. [3YDY.NNY,ApF.! 13 D1HR <br /> AM, 0M HUtA.w DwN.E.MM.WNM 0cro..ceMEDE VAw ❑vAPD1[M..erNNMu�_ <br /> Submersibl a 1:3.11. .... 1 HR UOMH MEIF QT 35 M. EN.T.1M I <br /> RnaT-@xisting pump (3UUT N ,Mu DOE...A.NM.. ❑ .aE eoI.ID I <br /> DQMAUcHUMI <br /> 11IHPIQH. El... OK OF M[ QCAVA H OU.OF CONDUCTOR CA _EYO [ <br /> t1 <br /> )(P UOUHHCMRAVATX 0.1.1 TVR R CAYNOnTTn . 1.1 UNw <br /> 0 MUAII..OI.. 13. QrtROE OROVF IFN CNC. I <br /> L 0MOAHO.1A0 ❑OTIMI 011011!NI.IMI.IV OIWT[R.INO NAN[ E <br /> ❑YONTONNO OMDrt N..NYNN.DV. DN. C..AFTE..E .1 ONYEh DV. 0. S <br /> A..,I LODE.CUT.bl1 .M rMA S <br /> TON.FO COM.TMOTNXMMEMO MMINO:.IOTAM AN MITMV AWP C.NE OTRR <br /> IHE"OV CERTIFY THAT I HAVE IEPARO TN.AMKAION AAM THAT TM NOW.VTLNDOW NAHHMONCF MEN AAN JOAQUIN COVMV OAIUQU C..MAT,UW..AND mR..AN <br /> CNMIV.W ATUM CERTEEE THE FOYONE.4'I COMITY THAT N THE RWOIM.WCE Q THE NOW FOR NnM <br /> ,IMF HTMAI 16 HOU 0.1 IQI.MT AUMOV NRMN MRRCI IO VM AA.AMA Q.MMUTON 4.0E CAtEOW[A'C <br /> SORT MIEN TN.RIMR N IAMO.1 MMt FM0.01v W RW xs HOUNG ORO wRawWAx'.coMMTI MTnoII <br /> CNRO OMxiM ALL M MOW N ICOM®IIIV! E 01,ANYM M.O <br /> MM NEA <br /> MA+I. Ce `�/,C.�.[ �Fm. 1J PY � D.. rlavmED <br /> • radr EE.N <br /> 0, HQUOT.OM NOADA MAMA!IOOM...THE MOHOUSE 0.LOCAIIDM OF HOUEFwAOF 0.M..OMM FU. <br /> M M OU..MYO D Q....AM ROM.DIIE I.M. I QPNIPOx OF M-A.T HIMU..EIMQE.. <br /> OHwMO....NID..HUM OF ALL RUIN AIO NO.ONO 1.LOCAT..OE MLL.—H..OF OIIF MINDED EMT'M. <br /> 11ICTVP.0.NCHOMM cOV[RO ARA.NI[N AS PATIO..MYEWAV.,AMI WN O. OH TM MQHFEM+Y OF A➢MIM.MM4UIIY. <br /> 1 V �. <br /> s <br /> APR 15 <br /> L <br /> TNN ONMEONME U N WUIQII <br /> Illlll _ UBUC FFALTN SLAVICES <br /> �- - " MALHEALTH[1NS M <br /> W.MN .I <br /> OF CIL� � Tw[ex.T ''A a �S <br /> Lar eIN M M. .N.iw�ry IdH ? vM 7 ./O Dd <br /> Dsu.<IN.N.e�I r D.• <br /> i 6— <br /> NO! FA.. <br /> AAAMMT—MH- CA.N 11[CNQ[T DAT[ PEMENBINC[IIIOWiE1MM IXVOI[F <br />