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APPLICATION FOR WELUPUMP PERMIT r� <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON,REFUNDARLE PERMIT EXPIRES 1 YEAR FROM OAT[ISSUED <br /> ICemp4t#IR1rlpOe#tI) <br /> AMT ICAT ON IR IIERE BY AIAof TO TIE RAN JO A OUIN COUNTY ton A PEMMT TO CON lit nUCT ANnMM INET At 711E%&T)W OE RCIRRFD.TIRE ArILICAI ION IR MADE IN COMPLIANCE WIT II DAN <br /> JOA OWN COUNTY DEVELOPMENT TITLE,CHAPT FR 9.111 6.3 AND TIIE RT A NnAFOR OF RAN JOAOUIN COUNTY PURt IC IIF At 111 REnVICE R,ENVIRONMENTAL 14FAtTII nMBION, <br /> JOB AOOWIIII IR AM, s J I I" -r' _-�— CUY 5-n+c, PARCEL RIZFIArN1 <br /> O—IO NAME_M0C0 e �E1�RLX- E✓t ADVN Out'54G}1 �Y'Pl�' _ Y� y C-k m"Ne/_Zo9-9i3s-2150 <br /> CONI MOTOR � 7C �yLV 1f C7tr L� �Y1L ArrnrrRell►i'Fi"Nl�dat�e-'Eh1�p11cF706) a ep - <br /> �- 2 <br /> / /,I 349 ke4 �1!A'95* /oQ a/ <br /> RIM COMMCTORFfx./t LNVrRAUN,EI•i{I',L- GAIUaMIn 1 �VI(S� AtITN1EER��ea��'I3'p�1,ta'�'=�s/'js llC/Y�V 3CJTJ� lit-30f) <br /> p\ r'1 E / PIONS IZp9� 1��.�J'sl� <br /> TYPE OF wt-t I_M,P {) NFW WM(p/ ❑REPLACEMENT WF1l El moM.NNU Vitt/ pal <br /> rt'�T <br /> INSTALLATION ❑WELL BYRTEM ni PAIn 0 CMRR.CONNFCT nFrAIR 0 VAPOR FXTMCTK)N WELL/ <br /> U New I]nw,•eF H.P. mmt M-Mr RfTIT. rlPRT WATER LEVEL_ O <br /> nvrf or nrMn -- <br /> El CUT or.BT"VK:F writ Q prem—frAt.Wrlt/ t] Bolt"O."n I <br /> ❑DE"rlR/crlov: <br /> IN�rTENDED USE TY►EO W CONIrRLECTION IPECNICATIONI •A <br /> tJ O DU.TMAt ❑OrLN BOTTOM VIA.OF WEIt EXCAVATION ENA.Or CONOUCTOrl CARRM O <br /> 171 OOMERTICA•TeVATE ❑ORAVEt PACK 7MZF tYrf,Or CASINOMtflffl V. MA.Of writ CASINO p <br /> ❑M0111CIMU MCO'AL OIEVtN OErill OF nnOUT REAL -Te�L T Of'Wr SPtCKKATK)N QQ /' 1 R <br /> 1111 IRRMATKiN/AG ❑OTIKn PROW"EAI.WIT At(ED <br /> f{yB,Y GROUT PRANG NAME PO- EtN C NAr_w7-'E <br /> yy MONITOPNIO f COMM IFAL PUMPED:WI V. 0 N CONCRETE IEOE#Tlat BV DPLLER:❑YeS ❑Ne J <br /> APPROX.or"" Lf II I tOCK*M CIMSTIR BO)IMTOVE PPF s <br /> PROPettD CONIT"UCTION/DPLUNO METHOD:MVO ROTAM AM ROTARY AUGER CABLE OTNEFt ir_i <br /> I HERESY CERTR•Y THAT 1 HAVE Prk PAIKO TWO APPLICATION AND THAT TIM VMFW WILL RE DONE IN ACCORDANCE WIT"IAN JOAQUIN COUNTY ORDINANCES,STATE LAW#.AND RULE#ANO <br /> PEOURATION"OF Tit[RAN JOAOU/1N COUNTY,HOME OW WA OR L)CFNEEO AOFNR't"IONATURE CFRTKKS TIM FOLLOW WO:'1 CFMNY THAT W THE PERFORMANCE OF TIMWOrW FOR WIIICII <br /> 1111"IEIVAIT 10110"0,1/HALL NOT EMPLOY PfRRONR MTBJECT TO WORKMAN'#COMFENIATION LAW#Of CALFORRA,'CONI RACTOR'S PORNO OR OU"ONMAC71110 MONATUFW CEMFKS <br /> TIK FOLLOWINO: '1 CHOLY MAY N 110F MIWORMANCF OF TIM VMVK MR WIIIC1111R"MrWrT II IOMMO,1 WALL EMPLOY PERSONS SUSJECT TO 14101ORMANY COUNW11AFMN LAWS OF <br /> CALRORNIA.' Till APPLICANT MVIT CALLIAPB N AOV NOI FO"ALL"iMAIIrO NIMCTMN#AT 1"014M 4422.COMPLETE.DRAWING AT LOWER AREA rPOVOEO. <br /> A TPR. �Jl 6i 1 V 1 QfIEJ I�Lf�J TPtl ��Elsf D.t. _ <br /> ROT RAN la wv le Bee1N Ubell I �I •I. Cpl <br /> 1.NAME#OF 111111111101"st11 /On R10 Ao NFA/E or <br /> TO On BOUNDING TIK rTDmttY. 4.LOCATION OF 1MU"E StWAGE 01111"MIY#TEAT On rRarO#FD <br /> !.OUTLINE OF TIK TFIOREMY,OIVIIO a..."'..ANO"or""CWWCTION, EXPANSION OF BEWAOE d#PORAL#Y#1EM#. <br /> S.bIMENI1D11ED OVItPWt AND LOCATION OF ALL F)ONTMU AND PrOr"S115 S.LOCATION Of WELLS WPNIN RADIUS OF ONE NUNTIVEO rWTV FT. <br /> I1RUCtUM8.IECLUDINO COVERED AREAE SUCHM PATIOS,OPVIrWAY#,AND WALKS. ON THE PROPERTY OR ADJOINING PROPERTY. <br /> Dr►MTMFITT Uar ONLY <br /> A..S..I AerLIS <br /> eplM <br /> O.aA Irrpeelb„BY Oelr � ne.y I,vPrllen RY bet. <br /> O•rlrre:.le•.TnePe<Ibn RY De1R <br /> fewew,e•1e: <br /> ACCOtNrNe ONLY: Aro/ FACE <br /> ►t coots TEE INTO AMOUNT REMITTED CIKCKHCASII AECiNto IY DATE FER111T/SERVICE REQUEST NUMIER 1NVOtct <br /> '350 <br /> Pub 4Belth Sow.-Enviro.173(1/97) <br />