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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERNLUES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX SRO,904 EAST WEBER AVENUE,STOCKTON,CA 95201988 <br /> I209I 4613420 <br /> PON REFUNDABLE PERMIT WIDE$i YEAR FROM DATE ISSUED <br /> D'REIMd M TIIPILRbI <br /> APRICATION I6 HIM RY MAA TO THE B.W JOASIM MO MR A RIMR TO CONSTRICT AIbpR IHOI.LLL THE MOIR CEKMEO,THE MNCRTMHIR MMEMCOMFLMYFN'RN 6AN <br /> bAOMI CONRYOfVELOFMEM Trt1E CNA RB-1116.]M TMEMMOAMO OF&W ARAdR.EO RINK HFA LT1H 6M,YKED.EWRONMEMAL HEATH dNeMN. <br /> ARS A... . `f� 4Kic. cnAR� Cm �, k IV PAxaeMNAENI <br /> .NNER.RAFAF SES. .o49 e siss SD✓ an AR CA WEX Siez;riz- <br /> C.HTMCMD :ter „<., ,Y,.NMRP.T..[]dav ACCIEES <br /> .X.HMRRCYSN Ra.Je,[nasi .Q..oio• L'snna✓,P C�( fl��/ RMRrR•X635 <br /> R o HEW V.ETI. ❑19LACEMExT WV. o MEM,EISNO WELL I� 13 OTHER <br /> ❑00H.TA14 []WELL eYe1EM PFPAN ❑CTeeCdNECT R CJ VAWe ERTM[ItlR.. J <br /> ❑Hwo FAM, HD OEPM MRAFsI. FRET.ASI d <br /> \RY1,00FRMPI n 0OMOAeERYKE NELL ❑.,.. A.. 11 .0IS0. R <br /> (�oE.TMKTR» 1's � L�Aeyr �, /17W l0 RQ�,N,�t!/y/oz z Fern aF /' w�.Sm <br /> ❑MA A.ODARE ❑oPERRmr.M NOFWELL E]CFVAnDIA.OF CONOOCMRC,Imm R <br /> ❑DOOFAT McVATE 11 A.PACN.. TYROFCAAI B EINVL DIX OF WFLL CASINO O <br /> ❑IOMFCMUXFI. 13d4VF11 OEPMOF...AL SIFICITCATION R <br /> 0.... ❑OTNER OMM REAL MR.eV OIWM NANO HAe1F E <br /> ❑...MR. ORMTRF Ro:0Y_ [3He COMCSMEMARAL.Y.MLLEROY- <br /> FISHER.OEFTN LCCNINO CIERFR HD STOVE RR . <br /> REPORd CORTRUOTONNRWXOMRWO:MWMTA MRTIOTMY CAME lHM <br /> I HERESY CSMIFY THAT I HFYE RYPAIEO THIS AFRICATRN MO THAT THE VAW.WIILNGONE N ACCORDANCE ASTM Wl MAWIX COLMY OR'ANMCE.,RATEV AHO RXER TO <br /> A MRATOH.OF ME RAN JOAOUSH COUNTY.HOW OWNER OR UCENRO AOdTS NOHATUR CERTIFIES THE MLLOWMO:'1 CER IFY THAT IN THE RRPoPMMCE OF THE NOW.MR MICH <br /> THIS HEARST IB IRNMO,I N WI MOT HARDY REASONS WGECT TO WORRIAM'.COMPFNRATOX lAOH OF CAWMM1'COMRMMPY HIRING OR NRECOMRMMO RADIATORS[EARNER <br /> TIE iOlLOW1H0: ' FT�Y MMTNf RWOPMAMCE OE TMFNOT'IOR WNICMTMR pEPMrt"AT <br /> e leeYM,IBNALL NlRNY 1fAMM BW""** AR`COMIBI.TON LAWS OF <br /> a.WPoRMA 'HAIR eyIeT WWIN AOVAXCE FOR FLL ROIM®MXIRMNI NyY9.WMRETEdU.VAEOMMVTP NEA Rtl <br /> PMr MAIIE.M.I.wJe.w�'., 60, <br /> RpNRTV. ..LOCATOHOFXOURNWME .yIOl RYeEMOR ROWREO. <br /> OUNNEOTN WUNDIF M ATIQFI OFMAWNEARNMRMSE RON OP.fWA dePoeN .1 N. <br /> 3. AXOIOCAREA.F M9 PM MOto.M R.MTHREFMFNELLR NTMIx RADIO.OFOMXVIAROIFTY N. <br /> OINCLUpIN.COYFIEO AREA.RAT AS dEYEVIAYR.PxO W.W[s, FWR:RYORMMININO MbRRTY. <br /> �CIL�i:lu• �� <br /> MIA <br /> DWORTMdT YIEOMY <br /> A„II„,H�A,�.,..�� .X.N•ay.9L 3502 <br /> C.�m.,., L�Ih, nd �ilzklen EL�crt�4chrvenf- enm11' �/�84(/ d2kd 425.91v <br /> POCOUNHNGONLY: FMI <br /> 3W_0bdWK4rvm 14-qq.q�, <br />