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APPLICATION FOR WELUPUMP PERMIT / <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES 1/ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 (� <br /> (202L)V"20 LO D l In'A S <br /> IIfLA��P A EXPIRE! 1 PEA/FROX DAT!MSVEO <br /> APPLICATION IS IEA!eY RADE 70 THE 6 /SI AN JOAqCOO MfY FOR A PFNSANT TO COFMPMT AND"INRALL 7NFWo1R DESCRIREO.TIfIS APPLICATION IN MADE N GOLw;IANCE WRN NAN <br /> JOAOLRN cOt�DEY[Lom ENT-TTIT E,CHAPTER 1.11111.7 Alb THE AANOANO■OF SAN-.OM COUNTY M N1/C III, IEgvia I.EMrIR(NMAENTAL N[ALTH FAMINON. <br /> JOS ADONIS.OR A1AN/ O 't L) p -_I <br /> �OD I PARCEL etZEJAIMF <br /> OWEENYI NAAE4 ADDIEII-.11�5' QA•:T2 • lL2ylJ��Ifi Sap <br /> CONTnACTof A e �*Sl-�'-�� 7�i� '�•O <br /> _F.Ow F <br /> •ue OGNTRACTOR LIfJ 1 /LL 4 ADDRESS y !S- •/NVQ^ y1 ' PRONE A- <br /> Yom[of Wl1.L..VAr: ❑NEW W,il ❑REPLACEAETrt L•m ❑MONDoRND WELL I ❑OTHER_ <br /> ❑INSTALLATION ❑WELL■VITEN REPAIR ❑CRO110{000,1ECT REPAIR ❑VAPOR EXTRACTION WELL♦ J <br /> D Y14 OF PUM►I <br /> EIN�•`❑�'• NP. DEH PIMP SR R. FIRST WATER LEVEL O <br /> ❑OUT-Or-IERW <br /> VIcF ELL ❑nEon Yv�C-WELL I li! ■D1-■OR,ND / <br /> �OFTn1UCT10N:�.F�t!/LL w/ PLN� / " I <br /> JF /ndLA-+v.tiG /moi-roc 1 N 1•>�..B.Ir,O <br /> Ni@/OEo As iimmmomu CON UC qr Y 1 CATIDAII /f1 <br /> A <br /> ❑INDLoff-t ❑OPEN BOTTOM MA.OF YR a A.OF CONI)M TOR CAeIND O <br /> ❑00MEITICIPPf—TE ❑OMYTI,PK.IU■!rE_ TYPE OF CASIIFefIT[EL/PYC MA,OF WELL CASSq O <br /> ❑PI/NICMUNICIPAL ❑ORIWN OFRH Of GROUT NAL _ SPICIFRCATION A <br /> ❑IRRIGATION," ORDITT ZEAL NITTALLEII BY _ <br /> BRAND NAIR <br /> ❑MONTTORNO ^ '^/r L,d'L <br /> -07 dlrNf -- OROLIT SEAL PUMPED:❑Y- <br /> APPROX. <br /> ❑N. COF�iCT [IqT PEpE■TK■Y bWLLFR:❑Y� ❑rN 5 <br /> APPRON.oFfTH_ W I �-�-O ' LOCRIN O CHEFTFR*OXMOYE PRE S <br /> PROP"■EO CONITWCTTON(DFRIRTO eRTHOO'NRIO ROTARY__AN FIOTMIY AVOER�CMl! OTKU <br /> 1-IEW CFM-THAT 1 HAVE PREPARED THIN APPUCAI PM ANO THAT TIE WOW W,,L BE <br /> DONE N ACCOIOAFC•E WfTH GAN JOAOLRH COINfy OWNHANCES.STATE LAW*.ANO RULES AND <br /> REOULAY"M OF TUE SAN JOAOIIII C-TY,NOW OWNER OR L)CEN*EO AOEM'■IIONATURE CERTEES THE FOtLOWO10:'1 CERTEY THAT N TIE PER`-VAA-W OF THE WOW FOR WHICH <br /> THIS PFM.OT to M MMO,1 PHALL NOT ETFFLOY}!NOMI MUSIFC7 TO WOMU.M'I COMPETISATgR LAWS OF CAl1FONMA.'CONTRACTOR'S MING OR IXI CDMIIACTNO Oft ATURE CERTIFIES <br /> TIE FOLLOWING: 1 IITIfY THAT N THE MAATCE OF THI AMM FOA WHICH THIN PTWftT I*1■M1EO.I MALL EMPLOY AERSUN*ft"CT TO*ONSGFAN•I COMFf/aATrow LAW■OF <br /> CAJIFOISSA.' TM rt MINT CALL <br /> NO ■ K!FOA ALLRYdAREp NIFSC/10wS AT fYiM YJ�E!!�.�COMpg�JETE DRAFV�q AT LOWER AREA PROVib[b. <br /> ROT MR W.-IF N..1 <br /> 1.NAMES OF STNETT*OR"DAO*NEAREST TO OR ROU DIP10 THE PEO)FfRFY. I.LOCATION OF NOUN SEWAGE DIRPOSAL■yWTEM OR r"DMIED <br /> 3"OUT LIN!OF THE Pro"I'Tfy.OMW D■LENPM"AND MOM"DIRECTION. E%PARM"Of SEWAGE OIIPO■A IYSTEMS. <br /> O,fAMEE1�OlE0 OUTLNF■AND LOCATION Df ALL EAISTNIO AND PROPOSED S.LOCATION OF WELLS W MaN IIAb1US Of ONE W)NOIED FSTY R. <br /> STFNCTUIRS.INCLUDING COVERED Art"MIC"M PATgS,MAWWAYI.AND WALA*, ON TIE PRORRIY Oft AUXWWM PROPERTY. <br /> .._ l..J_.. .:..A.. <br /> i <br /> O <br /> /~ I <br /> = --ZGA Ef � 1— GAS <br /> 1 <br /> .1 <br /> r•• 0 1. '�I r'?`d`ti';J4. �'d <br /> :/RHE r <br /> t. /iLri FEB 25 1999 <br /> O+Y �{ <br /> .........L.. . . i f <br /> . <br /> SAN. °::I:•Nl i <br /> r auC�Eti.rH 9EHVI;.I <br /> ­NVIRONAAENTALHEALTH UR/fSlc:,. <br /> 1 e �� TIEr TtwE"r D.I oNlr <br /> AFFN.NI.R NeROItl c•,.SI'',�V .'2- <br /> OrM Lwpr Mn Rf` O.N PROF InsP.nM Ir ball <br /> D«It..tl..•E.F..,M e, /� ? C I�•••�C��/_r'—PAZ <br /> v � 1 � <br /> ACCOURRIIEO OIII Y: A/OJ FACF <br /> K GOOD FR Nffo ANI UNT MATTED ASH RECEIVED NY DAT! FELlAITISprVICi REOUE■T 1l1*.1EW IN mll <br /> 7- 15 y S <br /> Pub Ne1FI01 Serv.-Envirc.173(1N7) <br />