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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)458-3420 <br /> NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> ICGNpkla IS T1lplkml <br /> AFRKp1NIN I]HEM BY MADE 101.E SAN MAOUIN COUNTY FOR A PERMIT 10 G.H.RART ANOroN INSTALL THE WORN Of BCNBEO.THIS AIRKAIgN M MADE OR COMPUPNCE wall a. <br /> "AWN COUNTY WALORAFm Tn1E,CNATER 8-1115.9 MET INE SIANUAV V I OF SAN ADAWIN COUNIN w&K HEALTH SERVICED.ENAGUNIM mNmM�TH Guam <br /> .ro.ADDIM."R AFHF 374 Lincoln Center Stockton <br /> Pl. approx EL corner McClellor.Vickan ary rwcEL NZMAmEb McClellen <br /> S tt ng Dry can ng en an s 1 owe or 510=55'F-45b� <br /> omanaxMM c�o Donald T. BradshaN, Levine-Fr cke-RecoMmm#L EDD¢ryville, CA /14608-1827 HloxEa <br /> coxI.E. AOVEaA UCR HpmI <br /> w.comrwcrog Gregg In-SSCu, Ine. AOppfap Arrtln'e'z,'U 94553LICE CA-656407 THERE, <br /> rYT OFwyujF%MP' ❑NLW WELL 11....Gan WELL ❑MDWIOISNO WELL a ❑0111[, <br /> ❑INSTALLATION ❑WELL SYSTEM MPHR ❑IUM.IN NRECT GUAM ❑....TMCTx N WILL a J <br /> ❑Nw.OM/ HP. DET'.FUN,BFT_T. FIRST WATER LEVEL O <br /> ""I OF R1MPI <br /> ❑OYfOFBfflvRCF WfIL ❑OFOHN]IcnL WfLLa SOR wNNO B <br /> ❑O1...Moo.: <br /> NIFNOFOUEE O 40NaIRUC110N]PFCTCATIONa 4 <br /> ❑INW UNAL ❑ORXSOROM pA.of WELL f.2AVAu.. ?-inches pA Of CONOVCIOR CAM1b N/A a <br /> ❑CONU.MSTwAlI ❑OMVELPACNMNE TYPE OF CANXOMIfnA'vC N/A MA.OF WELL GREW NIA O <br /> ❑I .uGMUNKNAL ❑onA. OLTn OF GROUT SEAL Total Depth ERcMKATOR Cement-Bentonite E <br /> 11..Al... ❑OTHER OMVT aIK.RATTED aY Contractor GROUT aNHG NAME N/A E <br /> ❑MONxONNO OMYi aFH RMRD:®Y. Ow CORcNIEFE.UnALBVONLLERQY. QFY ] <br /> A...,ONnX 80 feet LO GUG.ME.lmwAmav%,N% NIA a <br /> M MUO CONUMUCIwNNMwxG METHOD:MUD ROTARY MR MIARVAUGER CABLE OIHERHydraulic Push <br /> 1"[Ma CERIIF"TNAT I IMVE NMPAFEO THU A ATM"MO THAT IM WOMI WILL aE OOm IN MCOMO E W1TM SAX J AWIN COUNTY ORDINANCE[,aI F UWa,AND MNE]ANO <br /> TOMATOND Of illF DAN MAOIIIM COIINIY.HOME oWMER OR MUISVP AGENT'S SIGNATURE CURIOS 111E pLLO VING:'I EMDE N THAT IN THE rtHONAANCf OF lRlf NON[FORMUII <br /> 1111.RM11T IS ISDUED.1 NIML NOT EMMOY FEIMONO BUSRC110 WORI:MAN'S COMPM]ATION UWS OF CMNOMIA•COMM<TOR'S IYNNG OR W.COMMCTINO SONATUXF CERTIFY[ <br /> 111E FOLLOWXIO: •1 CUn"THAI IN THE Ff NOPMAN<F OF 111E..I..WATCH 11110 FEMN I]ISSUM l SHALL EM0.OV PERSONS SU uECT TO WORWAN'a COMPFXSAMN LAAO Of <br /> CAUFOIMA' TH ANTMVSTCA ..GALS 1x ADVANCE FOR ALL MOUMNif] <br /> NED GUMTHXO AT MI. S.COMd <br /> REIiAVAIGATLOARRAREAROWOEO. <br /> NI.a] AAAA / � nN. Site Project Manager mI 6//2197 <br /> { MGT Iw.wl.wl.l MW_ <br /> 1.NAME.OF M PEFIa Ofl MADS NEAREST 10 OR BOTHERf.IWATONOOFNEETE S <br /> OpOOSFO <br /> 3.Gal'INEOf RRfY. ANG, NNRcl... EXPANSION OF MADE DISMSALSYS. <br /> ],DONEMERNED <br /> OWUNF9 MET <br /> LOCATION <br /> OFAM EXISTING AND FIRDFOGIOT I.IATINDEMLLE MON..1ONE IVXOGO 1.1Y T <br /> STRUCTURES.INCLUDING COKrED ARAIVAO PAiOD. MWAV..AND N THE APrtV OR AGMUNHO <br /> MOrtgTY, <br /> 110P ib73Z \\IIID r <br /> �__..-.._. <br /> B <br /> SO befined'I.1,` e rs , ne onsen ` c .�rVl pIl`I I <br /> _. <br /> Court on lama 18, 1996; Section Iv, Paragraph wrARTMEHT vat..IV �/ G <br /> n,w AXrM1Iw er ml. PMnr wren«,Br Daa <br /> mm.X. SSC rnrACO 2rPuLi Qq-2Z(.-L-. eXp[res ID-15,7- <br /> '21 P, <br /> D15• - <br /> 218 <br /> ACC.U."N.IT ALOE FACE <br /> PL COOM iEF IXfO MAOVNI MASTIFG .111G]IICANI RFCDVFO.1 DAIS IMWM/]x1NCE .—a- <br /> 1X09 <br /> INVOICE <br /> 2 5q qj 0 <br /> Pub,HEGER Saw.-Enviro.U3(1197) <br />