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81/28/2002 17 55 2094683433 FIFTH FLOM PACE 03 <br /> WELL PERMIT APPLICATION FORM srrE <br /> • MMGA ION <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SLRMES UNIT IV <br /> OMMONMENTAL HEALTH DMSION(PHS-EHO) <br /> 3"E.VYeber.Third Floor, COV95M <br /> } T <br /> K/�09)469-3449 <br /> L �rl'Y Yell �N w <br /> � �W�I ��� ��•� `�r�3 �r1i��1�[Ib6iI1�M�'1h sp11 <br /> JNWA-QUM MMMPMO Wk O WW"9.1211K. Ctpb P.A*c FMt W Snriar;�F�saRE D�s�w� <br /> �aeltt4 f� <br /> b001 T1rOn+;r C�► L�tyl�t Phofmffi , <br /> LU0 � o <br /> Cve�HNl I S1b ContaClor 'W ,E'3L lrl�,�r. sx t3 Gq-�►rs�-:w cies � �f����r�Z <br /> � Y T y�7fan <br />� Q t7�1 gQIgNB�Q1:( .MYa17pPLi�lCFl.IMWD"+W6f7't,OTF�) �OES�RUC770M{tilgvse q0+below} <br /> aE trOR�173A <br /> 00lIAA�NTS: <br />�� +Iv�f.Q1M sa ora.OF 9at@IO X W=TWW CAS4/GSr p YDS 8"0 WMJL CASW6 QW <br /> a ixTRlrCrlOrt D AaR to MMOWRIMPI CASNQ 7i 4XWS8� TYPE OF t.A Vft d 3TM q PVC p OTHM <br /> D vApm G Mw F=my VOTN cw cROUr -rVM TDSEUWo- a AUGM q HME <br /> D A04PARN 0 P119'1 Pori I GIWW SEAL PUW83r.- a Yet-11 we P19M MAi4MUM FRSE-FALL DEM 13 30 <br /> a SOIL carmc a wwa AuGm gmmr rx s <br /> � +iPPF"c aor+wan�rs+ -�`=� <br /> �S7bVT PIPE <br /> NOTE: OFFSITE BOROM F=Wft ACCESS OR ENCROACHMENT PEMTM. <br /> GALL THE UNR 1V W45PECTOR Ed VVOFDMG MOUR5 IN ADVANCE FOR ALL ASGUMM OSPEcncm& <br /> 1 hwwby Gwft Oat 1 hw@ prepared tht**pp9cWort=W dW"wank will be Oona in sceerdme with San Jcaqu}n <br /> Coulrty Ofd !S irld Ro i m mW ail appReable Calffun o Stift Laws. <br /> DEP&Mr- USE <br /> P�� r r tZ z6 <br /> Y <br /> SM MAP IN UNM N Fitt. ! - l op <br /> WOW PLAN DATM <br /> AOm AeycWM By. Gds wkm <br /> Ar <br /> pply <br /> G+nu�ratpectlon StrP&W l�epec60n Crile <br /> Ce:tn+dran 1rN0eofvn b am& <br />�t�MENtSI <br /> ASG ONLY` pea <br /> PS COOM FEF w Id10I11l L xgmfr Eb RdtK 1e Rwu$T DATE rerarrrr sWtvwE raouFs►s 41rO106 <br /> C-57,_,rr WG,_,"-wArvE;L— C+Sf Letter of Authwinim to ssn pe-nut-Enavadwmt doe-- 9/V/00 <br />