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I <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOABUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 399, 445 N. SAN JOAQUIN ST., STOCNTON, CA 95201399 <br /> 12091 499-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICompkt. In YTIPIknbl <br /> AutICATION 18 HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT AND/OR INSTALL THE WOR( DESCRIBED. THIS AulICATIOH In MADE IN COMRJANCE WIRL BAN <br /> JOAQUIN COUNTY DEV LOPMEW117u, CHAFFER 9-1115.3 AND THE STANDARDS OF SAN JOAQUIN COUNTY MEIUC HEALTH SERVICES, ENVIRONMENTAL UMTH DIVISION. <br /> JOB ADORES E 5/ 7 W . FVANoXT /- CJ-. cIry .$'fDc%�FEL HCJRff" / /k.. <br /> RWHFR B N M � i &9dQiATy a( elW..Jf e) A 5/7 /L/• J=/r/J ux < Sf RA /'/IRRmRE0 <br /> A B AD R BS <br /> CONTRACTOR a cF- NL ADDRESS O�AJG/V j . Al, my tih [ti/ t,CP RmNE . <br /> Bun CONTRACTOR )� //J",( DRES.7a /Ba3 ow *OC4i toy 7Kbf1 7V 19 NUVNt A WM 71P <br /> TYKOFWEUIUMUMN ❑ nmv WMAELL ❑ CEMENT WELL ❑ MONITORING13G WEJJ . OTHER <br /> ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CNB. CONUMT SMART ❑ VAPOR EXTRACTION WELL E <br /> (TYTE OF ❑ x... 13R<p.I, N.F. _ <br /> ❑ DESTRUCTION! o DDTOFSERVICE WELL ❑ OMPHYf CAL 0 WIBARN. �-s� CIO . � <br /> Do RffAmT1N <br /> ❑ INDUSTRIA ❑ oFEN � RAx <br /> OM IA. EXCAVATION T N�4. DI . D ABN Duo D A14 a <br /> ❑ DAMESTICARIVATE ❑ W <br /> GRAVEL PACm:E TYMDFCASlHQGQFELmVO AE'/4 DIA Of WELL CASINO D <br /> ❑ IAnfl13 DRIVEN D REO CA IT <br /> INGONAl11 � INSTALLS DBY ' BRAND EN� '�F <br /> HNORINGROW SEA RMoY� DRETE MATTAL BY DR FR: oY"� B <br /> A«IH � 0RYERO <br /> FRO.BSEDCONS,ADCTIDmDxM,NDMETHOD! MNNT ROTAUGER <br /> emu <br /> B <br /> I HEREBY CERTI" THAT I HAVE MWASID THIS A141JICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE EARN DAN JOAQUIN COUUJyOQXNAXC"l STATE LA <br /> SEQUI-ATIONO OFTHE SAN JOAQUIN COUNTY. HOME OWTUR On UCENGEU ATENT'S SIGNATURE CMUNESTUE FOU-0WINO: I CETTITY THAT INTHE ITSFORMANCE OFT Wk AUDI ISSUED AND <br /> WO OF <br /> NTRACTORT HIRING an <br /> HE WORK MR MICH <br /> URE <br /> ES <br /> CAUMRmTHE �' ri�C E FAR ALL REOWHICH TI AT MI AND CALIFORNIA,'m aeMPERSONS Q"o„L WER`��N; R;a":Tmx AW. A0 <br /> too TRIO — Diam <br /> MOT FUN (Orm Ip SeN.I Bem.Ip <br /> 2. OUTLINE OF THE MOMINYt GIVING DIMENSIONS AND NORTH DIRECTION, EXPANSION OF MANAGE CHOP(MML Via. EM OR R AFOSRO <br /> DRIVEWAYS,3. DIMENSIONED OUTLINES AGO LOCATION OF AM EXIDITINO AND MMSCO S. LOCATION OFWELUS WINES <br /> STRUCTURESO INCLUDING COVERED AREAS SUCH AS FARGO, AND WAUU. ON THE 190E OR ADJORTNOOIPUNS � ONE HUNDRED TIM Ft, <br /> DEPARTMENT USE ONLY — <br /> AppII4,Ion A<..,L, By <br /> VMS <br /> DaviImp.eDe , pImpd0mRv <br /> ACCOUNTING ONLY-. AID# FAC# <br /> PE D E. FEEINFO AMINAND REMITTED CORO 9OVER By DATE <br /> FeaHTI.IRWDE REnUIET NWRM <br />