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SA, PLICATION FOR WELL PUMP PERM <br /> �AOUIN COUNTY PUBLIC HEALTH SE _._ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> ROIFREFDNDAREE PERMR EXPIRES 1 TFAR FROM DATE ISSUED <br /> (CDmpWt i6 TtipDnul <br /> A/vUCAT:ON N ITEPE SY uAQE TO THE UH JOAd1w COV FOP A PEMOF TO OOR9TW)CT AMO1011 SISTALL THE WOMC Mt MO.TIIIt APPIKATUM N uADE w cDYPIJA}gE WRII tAH <br /> JOAOUW COUNTY pE WVIXCHT TITLL CHAPTER 9-1115.3 AND THE fTAHONp6 OF SM JOAOtRN TAUMTY FUA,,I\\C HEKTN ttR 1.fHNA0M4NTK NfKTH DM N. <br /> J0,AOOPESAgR APHI 339 T N DUSTRIAL Av V U UE �. �\I PO N FARCEL RVLAPw F2 5 9-300- }- <br /> mWN9T6 RAut NotZV�IAfJ UA SPA AmEtf �D�-r�61 Mon13i'c1 Dr, �jc�d 01�47�a! �(S4)385- 8Dy0 <br /> FLUORDAUIEL 72 7s7A -LD o !reMQ <br /> cONTRAcioR �i .once MARTIN- (.3 9455'3 M, yTONE Sb 3A'3`150 <br /> «,.cTHtrAACTw WEST NA2MAT DgILLO& fog1' Ammo cN OD'A cA 7574'0 m :-2 55`f979 ,He-t. % 6Z727t <br /> . TYPE t>F wELIJVUMV. ❑ Mw WE11 QMPtACTJ.IEM tA'fT.L ❑ MorfrauM wEt1-, � OTTRR vapor yTwN�j-or',+,y 41e\\ 0B-2 <br /> ❑ MOTAI.UTmw Q wm 6TSTEU R m" ❑CPOB ONNECT MPAM ❑ VMOR EXTMCigM VA:IF I J J <br /> mvTN Pt110 wr_FT. RVST WATER EF'EL p <br /> (I\'OE Of Noy <br /> Q ovrgatRlTct wE1J. O Dtoy.TOrx WELL, ❑ sok aorwN , <br /> ❑OE6ITWGTq W. ' <br /> INT"OEO URE TYPE OF'Yf1L COM{TNIIClgM tViGl/1CA110NA ' A <br /> ❑ wpUQ1gK ❑�0""soT u �( MA.OF MESL EXCAVATION /Z,11 PA.OF COIgUCIOR CAIIHO p <br /> Q oOMEFTYJPAVATE NORAVEC'A 'Z( 43 SQN() TYvt WcA ,fTomT fDTVL (RA-OfwatcAiINO 1„ <br /> O <br /> ❑ ARR)LMUNI QOnvEN OfnrN OFvwvr cFwl. 2t Ste JOFK tLAa� MEC1r m. SA 40 R <br /> Q NwwATR. AO 11 OTHER OROVr tE.c OIHT..uXe tYwntNAz Y'wt OROVT&Rmo N.i,f tDETLAUD f <br /> � u `TonNa COHCPtTEPEOEETKRY0MU .OY- 'KM <br /> AF. OFITN as �ee+ IpC7(Rq cNEET♦71 t0 OVE PIPE .T <br /> PROFO6W COM,TIRJCTOMRMf(11N0-Uwe, WO AOTA AEE ROTARY Amcor I21I CARt.E DTNEA <br /> 1 MERRY CfATIFY THAT 1 HAVE PREPAREO TMS AI'RJCATIOM ANO THAT THE WOIK WRL tE OOMi)H ACCOADAHCE WRH&xN JOAOVUI COUNTY OROwA $.RATE UtW.ANp Rvtt6 Aue <br /> RfOUI N[OF THE AAN 1O*O COI . N ONAIER M U "O AOFITT-f fRNATVRE CVRT f THE WEjDUANO:1 CVR THAT M THE PEM)IY111Cf 00 THE V W MR W R <br /> TM6 FT7IENT M M9 O.I SHALL HOT tM PERSONS N XCT TO WOft A f C PVMATIOM AWf OF CAGFdvaA.'CONTRACTORS MNND OR PIKANTAACTDq E NATUW CE 4TEt <br /> WE FOI10vw10: -1 CERTNY TI <br /> AT N E P9TORYANI:Z Of THE VQIR FM MAOCN TMt rVg M 41 E .1 W RRIONt NS r TO WOI .-*COMTSA OF <br /> CA{1f04RA. �iMM/'tt//MMjj�� 2• OI AD'AHCt IOA ALL REOYIIm A/T,a��110 couf FTE 00AM AT lWt'flt AREA Pfo g T//ry��jVT <br /> PLOT PAM Rl.w. 2W SAW 'h <br /> 1. OvTuH OF fTw't r" M IW. NWvo- TO OR tO NORTH <br /> v PROPET . AMM N O MOUE[tEWA6E p6 GVET OY'fTEM oA PIggOEO <br /> i. OVTIAVC W THC P11p/EAIY,OIVRIO ONEHtgW AMD MdltN O,RlgM, EXPANtgN OF SEWAGE OlasOfK 6Y OF ON <br /> !. PERETI6RINEO OVTMf AFIO IOCATTOM a ALL EXMTNq ANp FPgP06[D L IOCAT6TM OF WEBS WfTlllll FJtpuS OF ONE IIUICRD fs:TY R. <br /> 6fRVCTIJTmt.VdeLVONm COV AREAS IUCM AO PAM*,OMVEWAT9,AMp WM& ON TIE ROPfRT'OR ADJOfN10/IgOfJOY. <br /> I <br /> I : : - <br /> pOMTV WT O6E ORLY <br /> OwE N�. <br /> AYYMM AEwNR1 h <br /> owl I..wl�M Ow PtFw uw�f�l F o.lE <br /> DMR <br /> 0+66FR YRerh.RY <br /> ACCOUNTM0 OMIT: NOf PACT <br /> R WOES Fawn AMOIRTT Rftm1TFD cmec"ICAdu RmoviOST OAT,( FOSAT[/6fFVICE REDUE6T N SGT INVOICE <br /> Pub.HOSM Sen.-EfMM.173(1197) <br />