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SAN*PLICATION FOR WELUPUMP PERM <br /> AOUIN COUNTY PUBLIC HEALTH SER CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON, CA 95202 <br /> (209) 4683420 <br /> ROIFREFURDAEILE PERMIT ExPBES 1 TEAR FROM DATE ISSUED <br /> ICgmpLt.Y TtipDots] <br /> APFLMATION IS HERE W MAX TO THE SW AAOWM COVNTV FOR A REMIT TO CONSTRUCT ANOIOH MSTALL THE WOK DERCIOSEO.THIS APFLICATON IH MADE M COUPUANCE WR119M <br /> JOAOUIN COUNTY r1EVE1DPMFw TrTLL,CHAPTER 9.1115.3 AND THE STAROAROS OF SAN JOAOIIM COUUC COUNTY PYSHEALTH RERVIC[S.ENVIRONMENTAL NEKTN OMBOH. <br /> JOB ADOPEgdIOR APR. 230 ShASTRIAL. A)COUE - CeFY Woo FAACE,m ,A,,..l S9-3�- I({- <br /> OV.RETTB NAME NESTLE USA. BEVERAGE DIO&O41 TqL ACCRE R, 8W Ij.a A) B ja lIXW LE CA .7.03 PHONE 18 54'9-s9gob <br /> coNFRACTOR FwoK QAIJIEL GTS ADD.[q.7g5A 14 S7 LP STE —u0• PHO,( SR+ 3A-3`,/0 <br /> IVR CONTRACTOR WEST RA?-AAT'DRILIIA�(a CORP ADwm�P.il{cAltc4aYA'75742.ucrCTl*55'67'jPLANE PIA OR- '% <br /> TYPE OF WEI.IAVMP. ❑ IM[W\YELL ❑ K,RACEN-IEHT wE1J. ❑ MONRORND WELL s ����❑,,{{{{OTHER <br /> ❑ NRTAWTmN E3WVUL TEM REPAIR ❑ CROB OWWCTAWPAIR �VAPOREXTRACTIONWM0 VC ID/JE-I, <br /> ❑Nw.❑Nle.d H,I. OLPTN PUIB SET_". HRCT WATER LEVEL _ va-1Z <br /> O <br /> (TYPE OF Im'"m <br /> ❑ OVT*F-RFRVICE WELL ❑ OEOR[rTACK WELL I ❑ BO0.mmHO <br /> ❑OESTEIOOTON: <br /> IHTERO co USE TYPE Of'A'ELL CONITRNCI,OM aptclp"T1ONq A <br /> U WO(IgibAL ❑OPEN SOTTOM CIA,OF WELL EXCAVATION IZ bA.OF CONDUCTOR CAMNO 0 <br /> ❑ OOMERICARRVATE p OHAYLL PAM/$,,4`3 5AND TYPE OR CAQNOATELI ?y C. CIA.OF WELL CAMI,60 0 <br /> Cl FUBUCRIUNIC,PAL c]orovEN DEPTH OF BROW t*AL 2 rr� mew"ICATION SL14 40 • <br /> ❑ IMEATONIAO ❑oTWm OFOVT SEK gRTtK d West OAIMA'E OIOUT MVWO NAME QpQTLA1-1D <br /> 1IICp�A1I <br /> F <br /> 5A MOMTOMWO I OmvT SEAL MIMPEO: V. ❑Eb CONCRETE P ZTK BY Oftmag'❑Y— JR W $ <br /> APFIIOZ.OtPTN �S INN D""Y"q <br /> 5 <br /> PROIOREO COMBiRl1CTOMA}EWNO METHOD. 1R/0 ROTARY AIR ROTARY AWER IZGABLE OTHER <br /> 1 HEQSY CEMIFV THAT I HAVE PKPAIEO TWO APi ATION AND THAT THE WEHK WIU BE DONE N ACCORDANCE WFTH BAN JOAWtW COUNTY. NANCEE.RTAT[Uwe,AND R o AW <br /> PEO TIONC OF TWE RAN JOAOIRN COUNTY- HOME O R OR MENDED AGENT-9 eONATURE CERTIIECTHE EOLLOWINO:1 CERTMY THAT W THE PEHEDRMAMCE OF THE W W EOR WMCH <br /> THU BERMrt Iq KOVEO,1011AlL NOt FAOLOYP(fIRONt SVSJftT TO WORP?IAR'R COMPpSATOMlAYA90FCKiOTOOA.' COMTUCTOR9IIOENID O0.9VRGONlTR.LCTRaO®gHATUR CERTUTE6 <br /> THE FRLLO WHO: 'I CCT1ry THAT N TIE PFPSORMANCE OF TILE WONT FOR WHICH THRB/E16RT IE IRSUFD,1 SNALI,EMPLOY 0[IIgONf BUBIECT TO WOIQAC W'S COMIOE•A R IAWD OF <br /> SW - TN[APNCAEIZ� �H�yIq M AOVANCE FOR ALL M7.00 losmr-AT O AO I COMPLETE d1AW1N0 Al LOV1" POO, <br /> C <br /> MOT PLAN Orr S.PNI B.'I -To <br /> 1. "AUTO OF q PEETS OR TOAD[NEAREST TO OR bISNORtl THE PFI014ATY. 4, LOCATION OF HOUSE q ASX OWPORAL OYBTFHI OR Prom"O <br /> C. OVTINE OF THE PROPERTY,O V MEHRIONR AIO NORTH OBECTION, [FPANSOH OF BEWAOE meld CAL RYRTFMa <br /> a. OIaIENmO oVT X ANO LOCATION OF ALL ESISTRO ANO FR MWO a LOCATg OF w[ttR WR1BN MORRI OF ONE WnRMO Fite Fr. <br /> STRUCTVRER.01CLUMHO COVERED AREAV MJCN AS PATO[,OIBVEWAYV.AM WALES. ON THE MP[RTY OR AD""m FlOPFFOY. <br /> ..�.. .....b.. ............:.. .Y....:.... Y ..p... ..F.. <br /> ... .. <br /> , <br /> OOARIMFNT NE OIR.T <br /> A.MPINP <br /> A. OY 0... <br /> a•rA E�P.nlbn BY DW NPnP LRM.gerl SI ON. <br /> D�IAnRPN N.e..II..Ih oR• <br /> ACCOM7.1to ONLY; AID. /ACJ <br /> PE COOP PQ INFO AMOU MCFAIT ED (`rJPRv ICASM RECRVEO ST OAT[ P6OAITT/ERVICE RmmT NUMBER INVOICE <br /> S , <br /> Pub.HBBRD So".-ErrArO.173(1/97) ' <br />