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"PLICATION FOR WELL/PUMP PERMIT <br /> SAN ....AIQUIN COUNTY PUBLIC HEALTH SEF ;ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, STOCKTON, CA 95202 <br /> (209) 468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICompbtu In TTlpikela) <br /> 11MIT To CONSTRUCT ANDtOn ALL 114E <br /> AMICATION <br /> COUNTY19II DEVELOPMENT TRIF.CHAPTER 9-1116.3 AND THE STANDARDS OF SAN JOAOU N COU ­5 <br /> PUBLIC HEA HEALTH SERVICES'ENVIRONMENTAL 10DESCRIOttY THIS APPLICATION MADE <br /> (DIVISION./A7NCQE�W/f�Tll SAN <br /> JOAOUI 1/ / ec.TlpAl I 1 CITY MnCEI SIZE/AFRI/ /Q• - L•4,`l� <br /> �� r <br /> JOB AODRE S"/OR APNr1�G (i 7 ---�-� PHONE 0 <br /> ADORES" �_/3 <br /> OWiJ'ER'S NAME 2/e z-1 �r PHONE I l <br /> ADDRESS Y�G) 7 �/M tli UC/�— <br /> VI. . .r_1.1 / Z� <br /> CONT MCTOR ` ST�(' 1 LO/ PHONE l <br /> ADDRE B" UC/ <br /> OUR CONTRACTOR r� <br /> OTHER " <br /> TYPE OF WELL/PUMP; [I NEW WELL ❑ REPLACEMENT WELL ❑ MONITORINO WELL VAPOR EXTRACTION WELL E J <br /> ❑ INSTALLATION ❑ WELL SY"TEM REPAIR ❑ CROSS-CONNECT REPAIR O <br /> DEPTH PUMP BET_---"- FIRST WATER LEVEL <br /> ❑New El Repdr N.P. g <br /> (TYPE OF PUMPSSOI(BOnINO�— <br /> ❑ OUT•OF-SERVICE WELL ❑ GEOPHYSICAL WELL+l <br /> ❑DESTRUCTION: - -_ -- -- - A <br /> TYPE OF WE CONSTRUCIION SPECIFICATION{ O <br /> INTENDED USE CIA.OF CONDUCTOR CASING— <br /> INDUSTRIAL <br /> ASINO <br /> ❑OPEN BOTTOM DIA.OF WELL EXCAVATION_ b <br /> ❑ INDV S7 RIAL CIA.OF WELL CASINO <br /> tYI'E OF CA9INOIBT EFLR'VC B <br /> ❑ COMEgIICMIVVATE ❑GRAVEL PACKISIZE SPECIFICATION <br /> DEPTH OF OROUT SEAL_ - <br /> ❑ PURLIC/MVNICIPAL ❑DRIVEN �,__�----`-��-y b NAME E <br /> ❑ IRRIGATION/AO ❑OTHER ,4 s` -7 �" L DESTAL BY DRILLER:Ely- ❑Ne S <br /> 1941 5 <br /> 11-49/1210 OTHER <br /> - INC.CASH 7140113276 I — <br /> KLEINFELDER, 2//J F <br /> STOCKTON PETTY ALJ ORDINANCES.STATE LAWS•AND RULE"ANO <br /> PH 2O9-948-1345 DATE HE PERFORMANCE OF THE WOW FOR WHICH <br /> 2825 E. MYRTLE ST. DR SVR-CONTRAC7INO SIGNATURE CERTIFIES <br /> STOCKTON. CA 95205 $ TO WORKMAN'S COMPENSATION LAWS OF <br /> S U LOWER AREA PPOVIDEO. <br /> 1'AYTO LITE /� ,ARS�' a,,,,,m,,,' - C.Ie <br /> ORDER OF <br /> Ind -tom E R <br /> OT VALID OVER $250.00 ♦OT <br /> DISPOSAL SYSTEM OR PPA(OSED <br /> 1 / li•OSAL SYSTEMS. <br /> UNION BAN K OF CALIFORNIA ` IN RADIUS OF ONE HUNDRED FIFTY FT. <br /> u EAST BAY COMMERCIAL BANKING IININO PROPERTY.T BOO HARRISON STREET,OAKLAND CA 9A612-3429 //� <br /> -- — --�-- <br /> ,r „/, ) ,R;RfY rARRa 1 <br /> MEMO (�� <br /> L: L2L000t'q ?I: 7L40LL327611' L94 <br /> t� [Ai <br /> r <br /> lAlk <br /> do 0j; <br /> : <br /> :.... <br /> �b <br /> . <br /> 9 <br /> ...... .. IJ. . L , I� �! E ,� . .. ' r <br /> N II I <br /> _. <br /> .... �-• iii r`I 7pJA��B .. <br /> i........... . I' <br /> :.... .... :...� : I <br /> • . I <br /> . SING- <br /> • <br /> • <br /> 4 <br /> DEPMTMENT USE ONLY <br />