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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 /> (209)468-3420 <br /> OF09-NEFUJIDIRLE PERMIT EX➢Illfi I YEAR FIRM Ull ISSUED <br /> "t V IGMbE■In TEIFik■ul <br /> APPLICATION IN HERE/Y MADE TO THS BAH JOAOUN C.VN Y EOR A PERMT TO CONIITRMT ANCHOR N/TNL THE-0-DE MPNEO.TIO/APPLICATION IS MADE IN L'OMPUANCE WTTH MN <br /> JOAOUIN COUNTY DEVELO 1 11156,3 AND THE STANDARDS OF IAN MAOUN COUNTiY PPUMM HEALTH/FAMEES.ENVIRONMENTAL HEALTH CNISION. <br /> JOS ADOKSSIOR ATNF 'T/I CITY cs 7 C./ "� PAICfI/12 FIAfNF <br /> OWNER'/NAME I" A... 5SO4L"" _ I"OW <br /> ACY <br /> cONTRTOR AODMOS 2'02-V F`�,4�.// LK, 37-13WPHONE P ier 1,J7 <br /> RLIS CONTRACTOR AM"" UCS nHONE <br /> "Of WfuH mr-, ❑NEW WELL ❑MPLJICEMENT VWU ❑MONrtopvw qu 1 ❑oTMn <br /> ❑NST�AU1ATICN ❑WELL SY'STEM REFAM ❑CROWCONNECT REPAIR ElSO <br /> VAR tXYRACTXW VVM, <br /> 1J <br /> ❑N. u IUIMI H F. DEPTH IRFIAP SET ". FMST WATER LEVEL O <br /> IT TRE OF PUk" — <br /> T-T/ d E.// ❑OUT OF/SEIIVICE wELL ❑oEOnHveICAAL.wctt, .[, ❑ ■O�R.,(eoFallo <br /> LLlMITRIFCTbN. l4 /VC/I r4V `mss p"#_,4 <br /> Y S'AakD /�� ]1 <br /> INTENDED TYPI O WELL CONSTR-UCC1110M OPI.CIIpCATIOM w <br /> ❑INOIIS7 RIAl ❑OTEN IOTTOM OM-OF WELL ERC.AVATION CIA.OF CONDUCTOACABNO p <br /> ❑DOME■TICAEIVATE ❑GRAVEL PACKtOrn _ TYPE OF CASNOMTECL-VC GIA.OF WFLL CASINO D <br /> ❑MU _WARNACWAt ❑rompt DMH OF anPVT GEAI _ ■PECIFKATTON A <br /> ❑SSSOATIONIAG ❑OTHER OnOUT SEAL MSTALLED SY GIn UT RRANO NAME E <br /> ❑MOWTOMM GROUT/FAL P1rmmo:❑Y. ❑N. -_ CONOETE PEDESTAL SV ORILLER,Ely- ❑FF■ s <br /> APPROS.Ot"" LOCRING CHESTER/0%!STOVE FIR s <br /> -am.=CONSTRLFCRONr0WtMPO NWIMO:LIR)ROTARY AIR ROTARY AUGER_ CAOI! OTHER 1 <br /> I HmSY CERTwY THAT I HIA VE Pf"ARFO TMS ATTLICATON ANO THAT 111E WONR HALL It DOWN ACCO1DANiF WIT"SAN JOAOUIN COUNTY ORDNANCEI.STATE LAW■,AND RlAlt AND <br /> REOtILAT10N■Of TIE SAW JOAOVN COUNTY,HOME OWNER OR UCFtMO AGENT'.IHONAI URE CERTlf1[/TM MUOVAINO:'I CERTIFY THAT N THE PERSORMAAICE OF THE LWMC FOR WEIGH <br /> T."14FM1T M RNK".I VHAIL NOT EMPLOY TEMONS SIISJFC?TO Ma"4 AR'S COMPBMAMN LAWS Of CALIORMA."CONTRACTOR'S MING OR yUi{ONTRACTNS S 04ATUR[CFRTwRS <br /> T71E FOLIO"": '1!/C�EIRCTIFY TNA 71A PERM~NCE Of 111E VVV K TOR WMCH TIM ME M ISWEO.1 SHALL EMPLOY PERSONS KWACT TO WMR AX 4 COM BAMN LAWS Of ^ <br /> CALWORMA.';y'),SrRCA C NO N A —ll FM ALL RSOtSHSO IRSPR TIOM AT IS'L11N.R--.COMPLETE bMWwb AT I—MEA FEO VR/ED. `111 <br /> A ',,^^rrll�-//L```,,��lICC//��//II�� j/pl/_ LI�Ll -lZ'L <br /> ROTPC"OZ ti Sa" <br /> L NAMEt of STFEETS OR NIOADS MARHT TO OR SOUNDM THE PPKWERTY. A, LOCATION OF HOIFK/SWAGE OISPOSAL SYSTEM 011 PIIOfOSFO <br /> T.OVTLNE OF Tw/RORRTY.OWNa LwLKNWM AND NORfN DIRECTION. EXPANSION OF KWAOE DMIOM SYSTEMS. r <br /> 7.DIFAFWK)FED OUTLMSAND IOCATXIN OF ALL*XWrI NG AND FROMMO S. LOCATOR OF WELLS RRTIN MOR"Of OM Ht*N F O FIFTY FT. 1 <br /> STRIx wim NCIEIDING COVETED AREA/SUCH AS►ATP/,DISVSWAYS_AND wALRt. ON INS 1RFMMY OR AbJ011wo NDFERPT. <br /> lit <br /> a <br /> 64A G_ <br /> PAYMENT <br /> JUL 1 - 1998 <br /> Y <br /> SAN JOAGON COUNTY <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVIS �. <br /> aA__Y USE ONLY <br /> A.F.S A..y TIY c DER. Aro. _2� 1// <br /> a,—H._A_SI_ ST <br /> DeNNaar.lr�ESXbn.T D.,. -7/;;,- <br /> Ih;yStto°f eve/ CZJ <br /> ACCOI:RTINO OMY: Nor-- 1 //nnyy FAC) 44( ,Ir-c- <br /> 'c Caere F.Mra IJ.Ha uNTR.11SO .— /IA.N RSCNm■Y DATI —,.■RV1Ct RCGV■)T-uwA"/1 N%lwc5 <br /> 37 o O 3 <br /> Pub Hoek SIN.-Enwo.173{1/97) <br />