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APPLICATION FOR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> U*lfFBROAffU F[Wfr FIRER I PEAR FRO*DATE I10ED <br /> Mw*%a I"TF4R""bl <br /> APFLICAT;ON IE I/ENE.Y MADE TO THE VAN JOAOUM COUNTY FOR A PERNMY TO CONWMJCT A NORM INSTALL THE VIONK D[1CPWW.The APIUCATIDH I MADE N COMFUANCE WITH SAN <br /> JOAONN"'1UWV DFVELOI.NE TITLE.CHAPTER 9-1116.3 AND THE STANDARDS OP SAN JOAOM COUNTY PIIR/ICC HHEE LTH�1EWOW tt.IRIEONAENTAl,HEALTH OF <br /> JOB AOURES"AIR ADN / J � cT' 1 N A'✓c-.I� _ vAICEl E@/AFW <br /> ONSNR'E HNA[ fir-- w T/)L /� AMME. l0'U ,o c- r FHow <br /> CONI MCTOR �t1J. ' �/REI ADDREs. 3(�LI-10'4 WO FHONE <br /> SII"CONTRACTOR AUDIS" LXX _PIK"*I <br /> TY►E Or WaLMJM►: 9 <br /> �0-W[u O F wft..' E[NT WLi1 O Nlowopom WILLS E3OTHER <br /> 11 PNWIMLATION ❑WELL MTEM IEPAM ❑emse COMECT RE►MI ❑VAPOR FxTRMTYJN KELL F J <br /> 13 H-13 R.[+ N.P. DEPTH PLWF 1El RFOU <br /> FT FeT WATER LEt!4 O <br /> n vFE of PLDMP1 I--T <br /> 11OUT-0E-OIJRVICE WElL 11SLOMIYSICAL WELL I Q SOIL same 7 19 <br /> ❑OE"TIIIJCTIWI: <br /> um u"E C*R*tffJCT"=Wk:Aj*Nw& A <br /> ❑IIDUITI.A1. OP[N eDAdV OW OFYV8L E71CAVATIDN DIA.OF CONMXIORCAS-" �4 O <br /> ��Q••IIT{��opAl[.fIGPWVATE ❑OMV[L IACTJLTL! �yrPE OF CA"IM'T[ELifVU. DIA.OP WELL CASINO D <br /> "L-I PUeUC "ACWAL ❑OTVB/ Den"OF OROVi SAL WTOMATION R <br /> �I A <br /> Cl A OAMNIA0 ❑OTNEJI GROUT BEAL IHSFMII BY 'ORMFF PLOW NNl[ `D E � <br /> ❑MOR.TOIWlO AJIDIJT amOf/AYSD'�/Y.. !b CONCIETE PEDESTAL BY W,T" I Y- ❑'. <br /> � FEII S <br /> AFFR01 OFN LOM*M CHESSONSTOW PWe /� S <br /> TNH►ON"Y CORNr%=F"HtM RlJ"G METHOD:TAW RorMY AIN ROTARY AMER CAME OTIltq ` <br /> I NE\ESY CE/OFY THAT 1 Huy[PA[FNEO THIS APPMATIDN AMI THAT THE WTI.Mi DIR WDON[M NI ACCORDANCE WTI/SAW JOAOUCOUNTY OROMANCE",STATE LAW&AND H.R[e AND <br /> IEOULATONS OF THE SAN JOAMPH COUNTY,"DOAK OWNER OR LOMMR)AOEHT'"MONATURE CTRiNE"TIE POLLevvo ;'1 CERTSY THAT M THE P[RFDIMEANCE OF THE WUN K FOR M OR34 <br /> TMS PIMDF W INSLWO.ISRF OY PERN3"MR ACITOWDPOMUN'SCOWWWATgNLAWGOPCMROWA.•CONTMCTOR'1/SENO OWMCONTINCIND SNNATVIE cl11TSES <br /> il1E FOILOVI.;: [ THAT IR E FEH�01I/NIC[OF THE VYFHM FDR WITCH THM RUe.RT IE ARMED.1 SI/ALL EMPLOY PEROON"MJBJECT TO WOR1011W.COAEMRATION LAWS OF <br /> cALM'OMAA.- f IT MD.7 ALL LE/IOL.M AN ADVANC.FOP ALL IIOVIRED NOMMMS AT 0-1 AEM.Jomm.COMMETE DRAVANO AT LOVER ATEA RF"M. <br /> ROT RAW pr[..ftN-*O- •%! <br /> 1.NAME.OF 1TIlETS OR'"AO"NEARER TO OR tOUNLtNO TNR PFpPERTy. E.LOCATION OF HDU"E.SEWA GI DMI'OSAL 1YeTEM oft rIDROSEO <br /> ].OUTUM OF THE PROPERTY.ARMING 0OWNWONS AND NORTH OSECTION. EAPANG"OF RWAOE DIPOSI A SYSTEM". <br /> ],"IMENMONEO OUTLMEI AID LOCATION OF ALL ERMTMO AHD PR Orono 1.LOCATION OF WALL"WFTIIM RADOM OF CFO HUNDRED FETV FT. <br /> 1TRUCfW".PRXUONO COVE ED AAEAS MJCN AS FATIO".UMVEWAY".AND WAIA". ON THE PROPERTY OR AOJO.AMO FHOAORY. <br /> r <br /> s <br /> t <br /> i <br /> r i <br /> .i... .. _ <br /> i <br /> t <br /> /r <br /> l M i <br /> L A <br /> �r <br /> AilAU.G i'1997 <br /> 5 : a .JOAUUN COUPITY <br /> .._...; .....-.r N..,..1 .r...,.......e... 7... •...� !. .......T...i ..�.. .: RIBCR±HEAL7H'SEFtYfCEB <br /> ENYIRONldENTAL hEALTH Mrwb1. <br /> OAARFMdTUN"ONLY <br /> AgA..SR,AaaIFM e[ ONIE 7 IMr � ,r <br /> BY O.ro <br /> ACCOV-040 6"M AMIE FAC, <br /> FE L'OOEA PR Nro AAIND1S/t fT® CH"[ 1CA.N PMEVED DY BATS Purl"M/INC["Remy MINIII 1111rghT. <br /> S b Q01 225 <br /> Pub.H"fth Sely.-Ervho.173(1197) <br /> 1 <br />