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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERV <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 00. BOX 380,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> 1209 469-3420 <br /> NON REFUNOANLE PERMIT EXPIRES 1 YEAR FROM NATE ISSUEN <br /> ICMmPIBN M T14Uestel <br /> AMCKIAMN IB HERE BY MADE TO TIM BAN"ASIAN COUNTY FOR A F£gMIT TO CONSTRUCT AMMR INSTALL THE NbPN GEMMED.THIS APPLICATION 1.MADE IN COMPLIANCEµNII BAN <br /> JOAQUIN COUNTY OF,A,UHMENf FIT ,CIIARFR 11111,31 ANO THE STANDAPDB OF BAN JOAQUIN COUNFY <br /> BLM MALTN OM✓MI Edy,E�M_N-Mr/W�I DNUd„pTNM MMON <br /> Op ADORES. 99,aI CTPARly20 <br /> O)2/T�E� <br /> ONMERB NAMEEAUOIy rgbymcaNRran Awae <br /> PHONE I/ � <br /> .� <br /> eue COwmCT.m'm)2?TtLI. Ppy' //V •c1vYUYNNF/V)9i[_ ADORE O 0 .3% <br /> PNONf <br /> TYPE OFµFUME ❑NfW WEM ❑R0.ACEMFMNmu MONITOMNO WELLF OTHER <br /> ❑MBtµUTION ❑WELL SMAMA AMIA1R ❑CMB°CONNECT RPNn ❑VAPOR EXTMCTM14 WELLI <br /> N-11 M1FW HF. <br /> OYFf OF WMq DfP111 MIMP a" IT FIWWATfRLEVFL O <br /> ❑OUT OFMli W'FLL ❑OfORrvBltµWELL I MK MPoM / <br /> ❑DE"MmnoN: <br /> l-A e <br /> �— N <br /> ❑INWdImAI ❑OLEN BOTTOM DIA.OF WELL EXCAVATION I. I/E ' DIA.OF CONDUCTOR CABINO /V l4' A <br /> ❑DOMESTICIAVVATE ❑OANI PACKMREO <br /> lVR Df eepmD/"Eftn>,/e � L IRA.OF ASIA.CAROM � //). D <br /> ❑MBIICRAVNICIIAL ❑loci MIR MAL MSCIMAMN <br /> R <br /> MRIOATmN/AO ❑OTNFp OMUT REAL MBIALLFO pY OMVT SAM NAME <br /> M.Womm <br /> LACK <br /> MANOR. • � / GROUT SEAL g11lFfO:[I,. RFT <br /> Yr ONs CONCEMMfFAL BY deLIFM1❑ Q <br /> Y« N. <br /> Rd <br /> P1ObSPlD DCONMO MR[R 11G.OVF RR <br /> ONSTIIUCNOMmMWNO'Um.: MVOMTARY AIp MTARY AUGER CABIL OTHfe At" <br /> E FA PF LL BE COM M ACCOMANC!µITN BAN"A WIN COV Y ORDMANC-f-B,BrAt7E UW,B,AND pULfCB JANp <br /> PfOVUTgNB OF TN!BAN pAWIN LOUNrv.MMF OWN ER OR LICENSEDAOEM'B MUMIUM CIMMUIES THE FOLLOWING:•I CERTIRY THAI M THE MKOIMAI OF THE WOq(MRN'NmN <br /> THIS mE Is NBVED,1 MIµL ACT EMPLOY FERMNB MARJECT TO WORKMAN°I..M$AMN UWd Of CµMOMIU.'LOMRACTOR'MMMNODR NBLOMPACTMO BgNATYM GERfTFB <br /> TOM MA FOR <br /> C`}FIFOLL�OWIN;�LRCryiMIf 1 .7'0 LL]MRANCISINAOVANCl 1011 ALLMOMRFD IMM/r/�M TpNB A"=;.NSONA EfMCOU. OM0.fT[OgMWINp Ar LOWER AMASMAROGRApNpIOLOMDIpPAMM UWBOf <br /> . P�7Llnj,.7' A.,. o lei,q- <br /> ROT MAN Idnv to S.Y.I SnSN�_•to <br /> 1. NAMFI OI"METS OR MA a A.T TO ORBOUNOMG TIME ANAMEMV. .. LOCA]mN OFMW[BfWME MBMSµfYQFM OR RmMeFp <br /> E. OUTLINE OF TNM RgFERry,OINM DIMFNPmNB AM NORTH DIRECTION. FKPANBpN OF SEWAGE ADE IMSY"FMB, <br /> G.OIMFNBN)NFO GIRIMFB AM LOCATION Of ALL EMI"IM AND MmpOPEO P. LOCATION OF N'ELLpµLININ MmVB OF OND PRIMPING F rf IT. <br /> STMUCTURES•INCLUDING COVEMD AREA.SUCH Ae/Ar108,OMVflVAYS•AM WALKS. ON TM FMPfRry Op ADJOINING PMI'ERTY. <br /> DERMIMMMT WE SKI <br /> -!'J/(T'tel L/j� /y-�Z/'_'j.. « <br /> Ann-11-Ana.Frrtl Blo D.I.... L 'S• / ✓ N <br /> m.M ImvrelbA eT LT D.I. PurO 1,,O NIAO <br /> D«uvnnnn Bw bn BY <br /> DEI. <br /> mmm.: yd Shan406 11 Nave k)lrjAL o�j r IM DIV <br /> AccODxnxa I1.11; AIM FAc1 <br /> PF CMEP In INFO AMOUNT RDMt4D LMCKIMASH RFCOVFO BY GAFF RER 'XS CI REQUEST NUMIM INVOICE <br /> 0 24 �5D �iS•`! I OIgo(a <br />