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APPLICATION FOR WtELLIPOMP PER <br /> SAIK JBAauIN COUIItTY:PIJ@LIC HEALTH S VICES <br /> ENVIR09MEHTAL HEALTH OMSIOA[ gSZbZ. <br /> 3EN EAST YY 3E'3s AVENUE SFOG'�K' K CA�'_r'" <br /> =1 48243M <br /> f _ <br /> XON-n"NDAIM!PEI= ME, <br /> AP4LI:.ATMN 15 HM EY MADE TO THE LAN JOAM MV=UMY FOR A PEMM I TO CDMST7NGT AM=wiSTALL T11E WOW DEC`-rOSE&k I APMJMATMU M MADE IN COMPLY.MCE WMM S`' <br /> JOAOLMN COUNTY DEVE3.DPwm ITTRLE.`CJ,7`Arrm s-1111.3 7p5.3 MIP THE CTANOArm OF SAN JOA0111N=MNTY PUB=HEALTH 69RVR'�FS,_64V111W1•REglTAL•HEALTH OMBtON. <br /> Joe AODFE:=VR^P.W L.O� �J 1•+� `1�p(�M� N�. .,1 Crry. _pAlK:ELj=iArw'•. <br /> OWNS"NAiE 1�SL� t�0.KE'C1r,.1S'r �`t'�Q�t�1`( Aaw+€.c?000 CRnw Cfll1`{aN PL. y00 r N 0.[�th rMONE�r3l�Zs�Z. 1-"L3� <br /> eoNrRA.-ro7r \amw1�Rz u-1►��(� CA'• Aop.��c �1. L�a'�- 33 0 sss 1 vo ck PHONE 0\161 <br /> atlB CONTMtAu'TOI1 AZKXWBS LIC_ PHONE <br /> _wEVJAl1 P- ©�f NLYvwELL ❑ 1@LACEkM f WELL mowropw wELL r,�� D vrrlr�l <br /> fl NOTALLATION ❑ WELL MY71rE;M"MW C ClX&-C ftNELT 1@AM fl vwrOR=m^-.mw mw vv&L <br /> D Nr r❑Psi Hl. . OE MW PUYPSLT Fr. FEW WAM LEM <br /> rt vPE OF RJ..PI D OLfT-0F;E77vICE wELt fl OEnwersaerAL WELL, fl MOL BOMMO f <br /> �OESTRL7cr7DPr. �� F\U_ItaC, CAS1N6 �.Q.or� 64Ztor �0 5�0��4�C.E.�1i.ai ZItiER��F. Q\PE 'Pt�O Ae4l`t1NQ> CA 4aESStiO A�a'o <br /> INTE7IDED LME TTYM OF WELL CONSTIUICT70N MPEClf r-ATw3-m A <br /> D PMUWVUAL D OPE71 MMTOM Du'.OF WELL EILCAVJffKM ONL OF CONDUCTOR CHEM L <br /> f ❑ DOMeM=fi MVA-M GRAVEL PA-Y.A-M TYPE OF CA9Aq!>;TE9,lPVC 00.OF WELL CAM M c <br /> I ❑ MnUC MMWCWAL ❑DMVEN DEPSH Oc wgtb T OEM: wem:CATM f <br /> f€ ❑ MmOA=WAc D OTHER O1QUr M%L DMT^t=EY amour!RNID NAME E <br /> ❑ reDNTTONarlc - - Of IDU:LE/L REAP@:O v. ow commem PEDEFTAL 1!Y musk-❑yr 0t,. .. <br /> APFM)L .UXM M CMEMTM 9OXMTV%M PIPE <br /> PROPOSED COST U,CMOMJD1■1= MUM M MUD ROTARY ASS FOTARY AMUR CAELF . . OTHER <br /> I HEREBY CERTIFY THA:1 HAVE FPIEPARM THU APP=ATION AND TKA;THE MOOMG WR-SE ODW Mi^=�OATH MAN JOAOIRN COLMTY ON1a N^M:Efi.STATE LAWS.AND RULES AF: <br /> REDULATX*m CWTHE GN JOAOLIMI Cou%TY..NOW OWNER OR t1C$O;M ADEN-2 SIONATUPE CE'RTWj=THE FOLLOWMIO:T CERTIFYTHAT N TME FEWOORMAN^-E OFTW wOPK FOR WNtC <br />` THM MP"T O RSUEM.1 SMALL NOT EMPLOY PE#SONM VU61ECf TO WOPXAEAWS CCOAMPMATMDM LAWS OF CAUFOM&4,., CON TRACTM M M WO M OR 5U&-=NTM 7*M S IONATUM CERnFM <br /> -EHE FDLLOWINT 'I TWCT nm PETFOMIAN'CE OF TW%0m FOR WMCK TMM POW,, a USUE�.1 MNAL' EMPLOY PEPOO M aml=r TO wDRMNAK'S COMPE77"Tmpf LAWS C <br /> :AtlPOFati1l' TFE 7M URS M ADVANCE FOR AL1>REouwm IMNIPMCTKws AT L!D/!tea. CO.Ae~--M ORAWM AT LOWER AREA PNpVOM. - <br /> x T7e._ _'Q+GENZ C-0t� �tZ4flDyiQ�n D.1. . \Z-$-d1� <br /> PLOT PLAN o...w Ss+d s... - s <br /> I. NAAAES OF STREETS OR TO OR MOUMIDMM THE PROPO Y. 4. U=ATION OF HOUK MEWADE DIeF4SAL SYSTEM 17R PPIOPOSM ' <br /> Z. OUTLME OF THE PFgPEP".O7I M DM4fNv ONS MID NORTH Vm%E'7 oK. E"A#NSION OF SEWAGE OMPOGAL eYST'ENMS. <br /> 2. IX&CDU DNED OUTLMM AND LOCCATOm OF ALL E7 Mm.AHD PHovocM .� - S- tOCATX M OF VRMLX MA7'NM RADIUS OF ONE NUPIDf[M PIFTY FT.* <br /> STRUY7VM.PfCT.UDING CDVEM®AREAS SLCN AS PATIO;•OISVEWAYS.AIS wA=L ONTME PROPERTY OR ADJOUdW FMFEKrY. <br /> MSP.- ON: BACK = :- :. <br /> . .: :: <br /> DWARTktff T USE&MLT . <br /> V ' <br /> Orme M>•s+ceb"B' Dow P, Mfw.ce.n BT D.1� <br /> ' Orl+ti+ctbn Irw.�at�BT Dat+ JDA- -1! �`� y <br /> CeernnwRt: a . <br /> ACCDU PffWO ONLY: Amt FA=f . <br /> 1 FE CODES k FEE MF•D AMOUNT RHdi1TEDr.-AAN mr:nvm MY I DATE P9AYpTJMERWCE REOUM FIMNREFI { INVo10E <br />