'�� �S���y}�Fr�'i• •`I f.�4��t L�'�7 "'�� � �''.r�f" x j r, :•;rt<�',��.i;,T - -...`�fi�y,`
<br /> �,?�r�'ytlS aid. ho-"i t�`Yr�-�*� i 1 � /:-L v,{v i 'N"'k} ��'' _,,r r✓i+� {F; ;-r .r�,�/ �.,•q i,''+a� � � `
<br /> ,•1`-4'f`4 5+' �Y7��•�+ r,,.1 �. V a.., i.`� _ ,t^t •r" c' ry,r:l�' da �n�,,.V '4+r:J �.
<br /> til♦7� `Y "Ir!f �'! ` ,�'` _. .4{ rt y .�;� < ^�' 7.
<br /> M11
<br /> 'j"t`` � i'`w�,A- ��'"> '!tF'•-w•�.r«ra-.:.•. v,<-M•.-...-., �. -.:v•. .. •r ' -.rv ;"- -tGMT�e+t',} ,p
<br /> �N t
<br /> f ,.a�,.c--s.r•�.rw� tv..
<br /> SAN JOAQUIN COURTY PUBLIC HEALTH SERVICES ,
<br /> SNVIROIQUXTAL HHALTH DIVISION N
<br /> _ 445 N SAN JOAQUIN, MORE (308)488-3410 �
<br /> P 0 BOX 2009, 3TO(MN, CA95201
<br /> BBPIAga 1 1RAR Qg DAIS I88QSD
<br /> ;(Complete in Triplicate)
<br /> "47� y �llaatltM�3D)M as 00"jUO a&(alal County for a perWt to cowtruet wWor'Irutal.l tAt vtxk bwln deJGtlfafd SLS&, ! raRT
<br /> I5+ Tr aplle&t1M L W!3a1'N+llrtt�"1rltY lot JoaQala County Ordlaaace So. 5,49 wA 1W WA the Rel&•" lep..Atloea of lion
<br /> jr� � rl&f�y1 �� �+uuT' ,I - `,y tCt.ys,• rl�- S} "L + ;ca�gi.
<br /> 'Y Y.. zrW Yr �7. !' "✓T A3-.I• - 9 .A.�r r( i n,.J: '' ,'t.'`Y,'._.
<br /> C,'y LOc U1R1/,lCCeyjf
<br /> J. '4t• r.r ` °�Yy7i'p">��`OMwu'&• � - Addrep �
<br /> �22,G'
<br /> ^ `�',GtLK `AOOraffx lJ � _Licensor ko. Z� ",aft
<br /> I AV.gLL'!13J WELL REPLACEMENT n UESTRUCTION C Out Of servi"'well 0l
<br /> e u;*1�''v ?�11 •`:T" b^r YT�tMt11 MItiT�1UAT1GF1'O •,.SISTEM REPAIR Ll R,
<br /> a ,;.yMmltorlll�Hall-
<br /> .1-1fJ !
<br /> ar. rr �:.OItTANCE TO SEWER LINES. DISPOSAL FLD 'Q�''��FRM UNE
<br /> 1 e
<br /> n tad C1+w F L 41FOUN"T10N AOA'CULTURE WELL OTHER WELL 'S ME/fiUAAIA`"" 1
<br /> r�' �3 h r4" 1TlAt0EDUf!' ' 4TYft0FWELL F'ROSLEMAREA IONSiECIFICATIONf ^"� P A
<br /> CONSTRUCT
<br /> -�,i�.s
<br /> 0,Ylataltrrq<,+1„•,', a'a0,01 wt 11~ Q Marossow, 04,of V44 Esta""" owst Wd cmkvi.�
<br /> MMo/ttfew ' t Q Orare1 Marl Q Tray Typo of Casing Spaadfadon& r" F +
<br /> tt �y rh +—q c w p^lls n'Alhf ;,'. fl DNI& D.P1h of GraA SaM Type
<br /> F u ..,.Mires: l 1 fiastxn _iud"Sael watered w g
<br /> a TwahiM► lUr` !!a1rAa!rP, H.PStaty
<br /> r Di�InrvAbl-rpt•- � - .-as.uas IC•terial i Dgfta _' '_ _ ,r � �•,, •
<br /> IOat�crL"a Depth. NSn�oJ k ,
<br /> R < 04TAI TOCIN Ik_flEFA&YAW710N1w DESTRUCT WN I i 1 epa
<br /> so rAW4
<br /> �.CwM1a1C1M �OIfNf
<br /> • ,•+�7��T N�'M� > ,NIM�O�a'I�a0af0 y.1.L... - ��fi, - t
<br /> .rte,„[�I�rrff�l�M�a1M•M�-� flF�r&f~�.� •:a WMI taCCr ,- r tR 1.� �;,,y '�t 4
<br /> Fou
<br /> WeapKxY_
<br /> Cap-Ay—
<br /> If,No,CempfarniwM �:
<br /> •y��,��� 'F
<br /> '�" '7t��iMMIT�LY�� �r - Ma1110dd •wl•r�+��rN�! *�►?�^�+e � x�,
<br /> t 4;t"a N YSd�h Ik , f.Yl►'''3� r.,l� r Y
<br /> J' py Qpl i d mowLmow. ll' rxletion
<br /> ,PrmoOMty, ; ' �, '
<br /> h. Cn +. r tGtetp,
<br /> 6MK t 4,HClr+�Ho.
<br /> &iLan of Ifnw h fvwy#7°° Total Mrgtt+/.t� "S N X161 C"s r h t a:
<br /> f 'Y IILTNI +i�' .e. ` •r-nr IO Siesf* :., We@011: ts01ar1 ,:., o PrOpN1�►LiM�•f'ttttcit+l.�?++dl y' }� R t •ti~i r.
<br /> :'7 Y"lTRwiS:*"."' '�"� �a`w�dd`t!&w. $+>•3;4' /' ..
<br /> x llTf ,w " �?�v''F lW� �urt�bar 7 .y AN -PT V,fl
<br /> NRi+ tit? �u s Ynace ty twlwat VOW IKn Fow dawn_.�Q__frroparty LIrw r { R
<br /> h� O •�-•
<br /> M1Ml1 OM int I fsw�f&NElre t and ow 1M work wi oo done in accordance with San JosWAn.00unly adrtM�lC�Yyqa:MMf'Mw4 ander'I
<br /> '' . :'. .-. :� i •1�•v':c'a-�'Sr'ra�`�,.i ' yy;»> t
<br /> �I1Maa/tke foiowft *#1 cwWy&.n In the pwiwmwxe of&4 work foe' "M+pNrrt faIeRIM.�,MMO ra3
<br /> 4 N r�l.��M�ll�teM&u a workman•&canpawnijn Isw&of Cs"rra.»CondaCWe$ttir*tp ole auftwsgtlYq pi�Mar+
<br /> k, rltrYlip'7 d ttr work for v0sch Wi&perm*4 Iawud•I afrel employ peraww a i*a I*wo I opnrpantp.
<br /> .Y i R 1•�e1`�P`^'I'a. �•Y'^1�Yy Vi�,1`h'�T. .�• ,. 4.•.. -. ... .. ... .. '�.fti�..L M^aY•'. ,1.. �',
<br /> .i i" • � � (♦r+ C "&Bwwv W1.
<br /> amp
<br /> Till.:: Uma&
<br /> . . z
<br /> Kw Dilp"TMEMT U"ON
<br /> 1Y " yq'
<br /> f A4+egMe•.l � +� Q&1e .n
<br /> `"�"`as faro lafetforr eta D&M._ FinM lnOactbn fly Aro& Dora � �.
<br /> `ar.. ^w jll " Haas:^ ,.. " .. .,. r- ,• b t.
<br /> ,fit 'IIdtRW►ttrl Carttr+rerttK`l�,rt._^�rara� �..:�a,.0 _ :,�, .. '. ...�, ;
<br /> s '•�!, 1'T. licaat - &cetera all co lee to '' Saa'J
<br /> . r _ ._. p oaqui■ Couatr Pualic pelta err3eea
<br /> -
<br /> Uviroaeental Neelta Perdt/services--'
<br /> ..4" ■ Baa Joagula, P 0 Box 2009, Atka, CA 95
<br /> fity^
<br /> �j t ,�:, + •AMOUMT i3tJt.::r 'AMOUIIT 11EMtT1ED a M 'atCIMD pY '60ATE " •f+ERarT'11p,; �..+
<br /> tCK
<br /> X
<br /> r
<br />
|