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APPLICATION FOR WELL/PUMP PERMIT lad <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3D4 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOR-AUVbbABEE PERMIT EXPIRE!1 YEAR rRUM bllTE I!lVEb <br /> IGpP1ftS k TrllRffre? <br /> JOAOLIIN CoI IA HERE SY MATY TO 111E CAN JOAOV.1118.3 <br /> COUNTY FOR A TTroMy TO CONSTRUCT ANOMrt INSTALL THE WOR[DESCMINIM,TMS APMPCATroN IF LIAbr M COMRfANCE WRIT BAN <br /> JOAp/1N C011N7Y rIEVEIOPMFM T,NE`2,CHAPTER 9.1E 1 S.7 ANO TIL/E�STANDARD/OF BAN JOAOUM COUNTY PkIRLIC MALIN SFrrACF/.ENVIRONMENTAt HEALTH omSION. <br /> JOB An RIFSAAIR ArWJ ZS"1 ! LCIti ITQC KC(d L,5 C@I�J Y') <br /> f• J l�L� �/� CIT'Y7c� /� PAFICFL BifffAPNf U-}f <br /> r0~11'/NARM�ii T�Ta,.I� A'.RE $ •.4�YrBLf SSSS ADDRE66 Cay/SII Lr'oc r^`. al FFIONFf ll��SryB <br /> CONFRACTOR 1"E E V A� I� jta V}tj %At <br /> •` I AonREef hh 1� p I+ror1E f S-n 171 <br /> BOR coNrnAcrort h 'u.il U.'IIII AC AOf111EeR f:L l71;./ ZZ31 G4Uu�1tp uc_ +�Itr ��•/� <br /> I.qM f IAP F/1 Tj <br /> Or wF umm ❑NEW wEtt ❑WFILACEMENI WETL 1❑�MnNF onom wEtt f ❑OTTIFR <br /> ❑ITISTAMAYION ❑WTEL BYRT EM rr PA$R L7 Clnee.Ccowa CT TNpAm ❑VAPOR EXTRACTION WELL/ <br /> ❑Ne.r❑Rr H.P. J <br /> OYIi Of PUMPT OEMII R/MP SET._FT- VAPOR <br /> WATER LEVEL <br /> Q OUT-or-SERVICE wrtt ❑OEo1TW6,CAt wrtc f ROR eorvllD V �► � C3 e <br /> ❑tlEBTR,1CTqur <br /> INTENDED UBC YP O 9 -C9N RUC IOR SFECIFIC ION! <br /> ❑IIIp1ETRAl ❑OPEN BOTTOM t A <br /> DTA,OF N4Lt EXCAVATION_ OIA.Or CONMJCTOR CASIM N fj <br /> ❑710ME@TICAT/VATE ❑OMVFL PACSIBfIE 1 <br /> EVES OF OARINOI$Y FFI A•VC_ MA.OF WFit(iAB,F%I <br /> ❑T'{RILICAMUTRCmµ ❑ORVFN0 <br /> OFMiI OF 01111Ut REAL_ � SPECKICATION J <br /> ❑fM0A7gN/A0A <br /> ❑OTHER 01gVT eFAL RlBTALtfb�/..Byy�Y� � Y{7.t 0—REN#l0 NAME❑MITMIORNO rIRRUF PrALPUMITO-LZTVr ❑N. CONCTfiI E <br /> ��''�� 1, E T'FTN RTM eV TMW.tFR:❑Yr ❑N. d <br /> APPROX.OEPfN lyW 1'-T IDCKRq CIN6TFR R0%16.OVF AIE <br /> ISIOTOfip OONf/1t "ONAM UIRS METHOD, woo VOTARY AIR ROTARY a <br /> AVOFR X CABLE OTHER <br /> I III! RY CFR17fY IILAF 1 NAVF PMPARFO TMS AFTIJCATRIN AM THAT 111E I VnW WAt RE Too- Of ACCOMANCF VRTIT SAN JOAOUIN COUNTY ORRMANCE/,-All IAWR,ANO MRF.ALIO <br /> MOULATIONS Of fHE SAN JOAOUIN COVNfY.HOME OWNER OR LICEN.ff)ARFNT'f 1110HATUr¢CEMSTES JIM TOtLOVYNIO;'I C[R1KY THAT IN Y1K R1�OIfLANC!OF 711E 1AIOIFf TOR VMSCII <br /> TIN/FEIIMIT IS 1@fUEO.1 pMLL NOT EMPLOY P[RfON.tUBJfCI rO lYOR1IMlM'/COMPM.ATTON LAWS OT CAtNV NIA.-CONTMCIOR'f r WHO OR MCONfRAOTRq Sg1fMW CETIFIE/ <br /> TILE FOILOW,NO; •1 CERTIFY fIIAT IN TILE PErOmMANCE or TILE WORK FOR N'111CH TMf PERMIT IN ISSUED.I SLIM,FMDLOY PEReoN.SIRLIFCT TO WORIWM'f lOMIARNATUREISATION rmoo OR <br /> CALIro1N1A,• f/li ARVCANY MUST CALL IIOW IN AOVAMC2 FOR ALL REOUIRM p1111000N/AT tT@fl AeS-SSSS.COUNL"t 0114WOM AT LOWER AREA PROM'FO- <br /> Blf.4 N /yf <br /> G <br /> or MAN ru...r.Rcr.I R..y •1, <br /> 7,NAME@ Or 11TI EFT6 OR ROAbf NFAMIT TO ON NOU"Op"VIIE PRDPErt", .,tOCATgN or HOUSE IIEWAOE pRPOSAI eYRFM OttPIIOPOSltl <br /> 13tw <br /> >'. NIF OF THE/110PCRfY OfVRq pAlEhwONf AND TIM"Oa4CItON. EXpAkmom RF ftmA rrf M•v...... <br /> 7. RMFNRro, <br /> oymxftm — n I TWO FKTY IT. <br /> n <br /> BRICK WAlk cA <br /> Z T 1 O <br /> 6 IT'I OVi.Rl PIIG I n fl <br /> H <br /> x i <br /> g €S€ }y y g OyERHAHG al - <br /> � ISLAN- <br /> 5.1 <br /> i <br /> E ESCALON ©ELLOTA ROAD ""C..."" <br /> D.I. A— <br /> Or.,A Ir+PrrAn SI b.l• rk"or"-"—Br <br /> h+rns,l.n I.wrrrl.,.Br ,�� O.r. CJ V <br /> Acco7Nlnno onLY, Mbf FAcf <br /> K CODES FEE INTO AMOUNT REMITTED CHECKOICASH AFCAVFO BY GATE PRMr7Isumci 11EOUtST""All" INVOICE <br /> 0/5 <br /> PDb 46alth SB .-Enviro.173(1197) <br />