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APPLICATION FOR WELLIPUMP PERMIT <br /> `/ SAN JOAQUIN COUNTY PUBLIC HEALTH SEN" <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O, BOX 988, 304 EAST WEM AVENUE, SON. CA SMI v88 <br /> 4209I'4n-3420 <br /> MWIFUNDAILE 10EII.M7 EILpUE! 1 •■FIIOY UNTIL wE0 <br /> APPLICATION <br /> IS ABLE SY MADE To THE ENI JoAaUM COUNTY FOR A TERMER To CON AND�AIS �D��THE VMNN DESCRIBED.TWO <br /> ' <br /> JDAaURN COUNTY OEVELOPME/T TITLE.GNAWER P111 5.3 AND THE STANDARDS OF SAN JOApEN a NPIIMEN Ai IS MATE DI COMPLIANCE <br /> E WRIT SAN <br /> c COUNTY PUBLIC HEALTH SERVIOEt,ENVIRONMENTAL MFALTN DIVISION. <br /> Jos ADDIESBpq APw ��i1 V �L <br /> Rr. .d�_ .L LI�6 • .4tT C <br /> ITY <br /> oPEEB II, L"�A&Y tO.ti PARCEL EDVAN <br /> AURES, <br /> MTAD � ,PHONE�_ <br /> LIOE <br /> segsr►L�E■3" LSESoI <br /> El/s <br /> ADDRESS PRONE Ob2la igme <br /> coNtNAeroll�C.x�.kyr ♦ r <br /> ADDRIE � $►ull LIOP4121gn <br /> PRIONS 113e\ue'fi..s <br /> 1 4u Asn T <br /> T ■P��-y.�.. E3 mw WELL ❑ REPLACEMENT WELL ❑ MOMfONNO VI I I3OTNEII <br /> ❑ BGFAL AmN ❑WELL SYSTEM RIE'AK ❑cROEEcoNNECT REAM O VAP'OII EXTRACTION WELL <br /> TYPEO PAM 1ONw OR,PW N.P. DO"PUMP BET��FT. ' VAPOR EX LEVEL J <br /> ❑OUT-OF-STWICE WEU. O OEOPHYEIOAL WELL M O <br /> t3 INDUSTRIAL <br /> ��� Eek EaL aoRINo N <br /> Y INDUSTRIA. 13 Dom BOTTOM DIA.OF WELL EXCAVATION 2PS'/1E. A <br /> 13 DOLLESTOMEVATE OOWAVEL PAocmn DIA.OF CONDUCTOR GASTRO D <br /> O PLISIICNMIMCEA I3 DSVHI TYPE of CASINO STEEL ROVE Du.OF WELL CASINO D <br /> DEM OF ROUT SEAL S SPECIFICATION <br /> ' O E"■BATIowAa �oTIET, GROUT SEAL NMTAUED BY y " <br /> 13•GMro1EG GROW enARO NAME E <br /> E� jn GROUT SEALLOCKERS <br /> PUMPED: EWE DR. CONCRETE PEDESTAL BV DFLLM 13 Y. ON. 3 <br /> APMOX.evrN-1-w��yE LoeNEa ellEsrEn BOXIeTovE PIPE <br /> "N"SSM OONSE■UOIMMAMMLMO METHOD: MUD ROTARY AIN NOTARY AUOEA CAME OTNE � S <br /> I HEREBY"T w OF THAT 1 HAVE PRIlAIfD TMS APPLICATION NG THAT THE WORE(WBL B[DONE M ACCORDANCE WITH SAR LAI COUNTY ORIRMANCES,RATE LAM AND RURES AND <br /> RIIMRATIOIIS THE SAN JOADUIN COUNTY. HOME DINNER OR LICEN ED ASIMT'S SIGNATURE CERTIFIES THE FOLLOWING:'I Mary THAT M THE PERFORMANCE OF THE WORK PON VINICH <br /> i TIMPEEIF *HMW,ISIWL NOTEMKOYFFRSONS SULECTTOWO MWS COMPENSATION LURE WCAURNINA.- CONTRACTOWSHN ORKNCOMRACPEMEN"aTUMCBMM <br /> TME FOUDW"G: 'I CERFY THAT M THE PERFORMANCE OF THE WORK POR WHICH THIS PEIEST M MMIFD.1 SHALL EMPLOY PEMOIG KI61lCT TO WORIWAN•S OBRIISINIITIOM RANO OF <br /> C IA!`SII AISSI T M f CALL HOME M ADVANCE PON ALL REOM MWWMNS AT DIGER 4M4M2S, COMPLETE DMWME AT LOWER AREA PROVIDED. <br /> SITISS .V� TARN" ®1� INN <br /> ROT PLAN Orw N S=W Sa.N •N <br /> 1. MASES STREETS OR ROADS MEAIEQ TO OR BOUNDING THE PROPER.V. 4. LOCATION OF NOUN SEWAEE DISPOSAL SYSTEM ON PROPOS® <br /> 2. OUTLINE OF THE PROPERTY.DVINO DEENMO/G AND NORTH DIRECTION. EXPANSION OF SWAM DISPOSAL SYSTEM. <br /> 3. OLIBIEDM®OWUNES AG LOCATION OF ALL EXMfMM AND PROPOSED S. LOCATION OF WILLS YMTHIN RADIUS OF ONE HUNDRED FIFTY FT.. <br /> STRICTURES.OWNING COMBED REAS MICA M PATIOS,DISVEWAYS,AND WALLS. ON THE PROPERTY ON AAIO"GG PROPERTY <br /> P►'RKicK>✓h 1'T1ENiP5 ;.. Ag(ires r- <br /> - �/�(�I/j �1N�'�Q�J1 \ DSMPMrR USE ONLY <br /> A.PS..Nan A..�NM BY. MAL �/1 ' wN C•J/ M.. <br /> GI M D.N P"H.YPKIbII M Dow <br /> DI <br /> CmdTrA.: - <br /> AOEOUNI ONLY: AAS FACS <br /> R COS/ PLS EEO AMOUNT Rome RO C ICASN RECEIVED BY DATE PEOBYSETO!l i T NUMBER MIVOIOI <br /> 61 <br />