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i <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION c*w <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-UM <br /> XQN-NUUUOAIR PERIMT EX}MES 1 YEAR IRON OATS ISSUED <br /> rGe"Ittt it Tripsnow <br /> AMICATIUN K I,ERE eV MADE TO TN[SAN JOAOUIN COUNTY FOR A PERMIT TO CONSTMRCT AMOlOR NffTALLTHE WOrN D[[CTvKO.TMS APPLICATION A MAOE N C'OMRIMIC[WMI SAM <br /> JOAOUN COUNTY WMOPFRNi rrTLE CHAPTTR 9-111 S.7 AND THE BTANCAme Of SAN JOAOIIN COUNry FUNK HEALTH SEIRWCES.ENVIIDNMENrAI WALTH CNMOM. <br /> JOB AODMUAR APPA 7600 WINDMILL COVE ROAD cT STOCKTON vARct11IEEJArR, <br /> OLWRA'S MAW W1NDMi1_I. COVE MARINA ADORESS SAME 95206 ,,,D„E, 647-0807 <br /> COMRACr011 NOACK PUMP CO. W/0 19403 ADDIEII 4500 E. FREMONT STL,C, 504513,,,, 948-8817 <br /> M CONTRACTOR ADDRESS STKN 95215 uc, "fowf <br /> r mGrymLm A- ❑MEW wru ❑REPL.AOtumm WELL C]MONRO"m WELL f ❑Oymm <br /> ❑NSTALJAT0.NF ❑WELL WMEM AFFAIR ❑CROSICORTECT REPASS ❑VAPOR ErrRACiON <br /> SUBMERSIBLE❑,,.-[&,.+ N.F. 1 HP DFFTNRRMr, 50 Fr. FIRRSTwAiMLEM �7`-, r <br /> O <br /> "RM'fu_W EXISTING PUMP ❑OLT-oF-wwAcEwELL ❑OEOR,/SICA.WILLS ❑ eDr-eMM0 e <br /> ❑oEErTRIerIO«r <br /> +relGtD uu RM:r <br /> A <br /> ❑SIDUSTMAL ❑OREH BOTTOM DIA OF W tLk EXCAVATION DIA.OF COtA7MTORCASN3 p <br /> RDOMEETCAWVAT[ ❑OMVEL PAGT(ARF_ TVPE Or CASMOATEFLRVC OIA OF WELL CAe1NO D <br /> D�T PUS XWt*0CVAI ❑ONTWH Dm"OF GROUT SEAL _ SRCIFICATIOM R <br /> 13 VS TIOWAO ❑OTHER GROLO VEAL MT ALLIA N OIOur SRNv NAME [ <br /> 0 MDRTONNO ORROUT SEAL PIMMO:❑VN [IN. CONCRETE PFMWTAI BY DRILLER.-❑Tr ❑M• 1 <br /> ArfROX.GOTH LOux-O C/EW"FR 10x/vTOVE—F ,r <br /> PROFDLY CCMST MTIOR/DIRLNM Mt/1O0: MIO ROTARYAlli ROTARY AUGER_ CABLE OTHER <br /> I/DIY CERTIFY THAT f HAVE PREPARED T/SS APPLICATION AND THAT IM WO WILL W DOME N ACCORDAM3 WTH SAN JOAONN COUNTY ortmAmts.STATE LAWS,AND Kul AIO <br /> WOULATIORM OF THE SAN JOAOtXN C*tWrY.NOMF OWNER OR L""WU AGENT'S"ONATIIN CERTIFIES TM FOLLOWA M'I CORIA'THAT N TW POWORMAN"OF THE WORK PORI VVFS[N <br /> THIS KFMLT M I—MO.1 SHALL NOT EMPLOY PERIONG M.ItCT TO WORNMAI'S COMMISATOM LAVA Of CIAX ONEA'CONTRACTOR'S"ROM OR SI/SLONTRACTIMO SIONATURE CERTIFIES <br /> TW FOLIOWNO: •1 CFNTRY TNAT MTM MWO1MAANCE OF TLE WORK FOM—M"TMS P"WrT IS RSUCJ,1 O/Ml EJAROY POMGIIS SUSRECT TO WORKMAN'S COMPIPSATION LAWS Of <br /> CALJF0111K' TM r CALL 11 NDW At AOV PM ALL IIFTUIII® r70ST ISS-lL1f��.COMREI[DIIAYNNO AT LOWOI AREA NONOED, <br /> 77; <br /> Re,RAA IM—h 0*"5r4. 'r. <br /> 1.NAME1 OF STREETS OR ROAD!NEArE ST TO OR SOIXROIA TNS fR1GR1RY. I. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM ON OOrOKU <br /> E.OUTLINE 01 THE PROF"".OfVNO VONNODNI AND MORIN DMICTION. EXPANSION Or WWAGE CISPOSAL SYSTEMS. <br /> UT <br /> 2.b1ADMOMM DLIIP11 ANO LOCATION OF ALL EXMT1q AFD PROPOSI!O S.LOCATOR Of WI LI Wft/W RAHIVS OF OFR HUNDRED FIFTY FT. <br /> STRUCTURES,NCLUOM COVERED AREAS MILIA AS PATIOS,ORVEWAYS,AND WALR1. ON THE PROPERTY OR ADJOIIAO/RO*"". <br /> .......... .. .: .. .. .. <br /> ...:..........: <br /> ...:.....: <br /> 0.0s W,CAVE Q fl ....... <br /> 1 <br /> , <br /> oS1 <br /> PAYMENT ;. <br /> .. <br /> :'NOV'l 6 1998 o <br /> HLL1 _Lf <br /> +so <br /> h14 <br /> ti <br /> TMSIIT USt ORLT `// (J <br /> J� <br /> APRSMMn Aw.FIM F_ C D«• I <br /> D.R..Ax...c,ro•.+r.,er Da. <br /> ACCOVAlIMO OMLT: Aq1 FACE <br /> n cpOEs rw N- uAGLNT 1 X 51 RXcwvm Pr /I v rewlTrr wvlct REGLRX Iruwww IMvotct <br /> 5(1) 003 i <br /> S <br /> Pub HGRM SNV.-ErrAm 173(1/9T) ' <br />