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77111 ll�� <br /> S <br /> APPLICATION FOR VYELLIPUMP PERMIT i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> xs, ENVIRONMENTAL HEALTH DIVISION � I <br /> P.O.BOX 988,304 EAST WEBER AVENUE,STOCKTON,CA 95201388 <br /> 12091461-3420 <br /> I <br /> WOR-REFUNDABLE FERMI EXPIRES 1 YEAR F11101111 DATE ISSUED <br /> rempMTe in TrlpResls) <br /> APtAtCATION IN HERE NY MADE TO THE SAN JGAOVIN CGUMV FOR A(ERMIT TO CONSTRUCT ANDIOTI IRBTALL THE MAK DESCRIBED.TWO AtTVCAtIDH IN MADE RI COWMAN"WWII SAH <br /> JOA"COUNTY DEVELOTTJENT TTLE,CHAPTER 9.1115.3 AND THE BTANDA409 OT CAN JOAVWN COUNTY MWe IWALT11EmAM <br /> UCER,EwrtDwEAL HEALTH bMebN, <br /> .IDR AORRESBION AKIN o� L• ;FF f. CITY_SU'-QK'}0•^\ __.. PAAcn mmApw <br /> GWeT[netrA*n�I�40C_Lal �re-1 _tla a#..,n Atwo+gk Ammes E-0] Atox )f0-7 nmwE *` Y21 <br /> comwien AnOrtl%e <br /> -L5()5 W•MARF.rF LANGJ�A tFCFj9OZt7lw"04 o7.0 <br /> Seel LcGp�. <br /> OUR CONI N4CT.m N 1}E.611 CAdbk!^ r A§J. .._. .�.AbTymes <br /> pw OF YrFLI1P!Em 0 NEW WELL ❑RXRLACFMrNT WFtt ❑Mow am4a WFLL■ 0 OTHER <br /> ❑I gmt.ATbtr ❑WELLsY9IEMnermn ❑cnossCnNNICInFrAm KVAFVRtXtMCTPDNWELLF -I VW^71 J <br /> ON•,•OR.P.a 14A- DErrNrvwsET_TT. tIMTWATERLEY[L p <br /> N YFE OF RIM% <br /> E]001.01'SERVICE WCLL ❑Oco"WSICAL WELL N O BON.soIYND A <br /> LJ rlrmm,c T1ON! <br /> My M IS klr rF 0 F OX TR FIO iPECR b A <br /> El fPMOTRIAI ❑OIEH BdTTOM NA.Or WFLL FI{CAVATION SE, owarCONIXMIMCASITOI "It) <br /> }!C�IFeyp pO <br /> ❑DOMI9FICRIWAlf tp ...'7. eEE TVTTnr CARIM1rATEt111.1C py '••-�- IMA.OF Wn2.CAMM A <br /> ❑mmit.A111NIC,rAt ❑nmvf" OFr`lHOFGrn1UI9FA1,Jjp_2e Iu�ae S�RFA(t IPTCrMAIION__.5t_11Q PVIQ A/lT R <br /> N <br /> ❑1 paVaMRAMNIAa ❑oTNER OROUF SFAL WTITAttW IY I( Mei k v GROUT SMND NAME PftR$IOA4 STV D L I E <br /> IN MOTOm GROUT 9FAi MIMrto:El V- Ne CONCRETE KOf8TAt BY DRRLER;t{Y•• (IN. a <br /> A—X.nrnN_- 910 Fc�Y., 13 LMIKIWO CirrelEn ROXAlove Tv/—ye�` <br /> nWPoer"CONIrRUatTON"N"AUNO MSTHObi PAM ROTARY AOI nDlARr.AODFpq K CARLE OTIR?L __ <br /> I RE-WRY CERTDY THAT F HAVE rMPARFO TOR AMVCATION AHD THAT THF WON(WILL IE FICK IN ACCOMAMF WITH BAN JOADUW COUNTY OnO1NANCFe,HATE L/lWll,AF16 RVLEe ANp <br /> RFwJLATbt,e Or THE BAN JOAOUIN COUNTY.NOME aMRNn On LICENSED AOFNT'S eiONAtURE cfmWrES TILE roUOWRATt•1 CrrrTIFY THAI IN TNF tE1g0RAlANC1,OF■TIE WOISL FOR WIpCN <br /> Ties rfmm M ISIUEO.1 MIAIt HOT EMMOY PERSOMIURJECT TO WOPWMAN's COMPMATON IgW/Ot CAIRORMA.-CO/fTRACTORY/TRs1q OR MIO C RMAN1CTRIO/11 VAOAKE CE Wane <br /> 71R FOLlaW1Ir0: •1 CI TITVCAN THAT M TIF PEIVO RS IN <br /> V L11E WOrK FOR w"'cH lone RRHTT"I,e I SHALL EMPLOY PTROONI SUeJFCT TO T worm M'e COA NNIIATOM LAWS OF <br /> C ALRpISR R.' TTI/AFyyICANT MVeT eAt!f1 H-OUTLR�I ekL�UI AUVANCI FOR Atl REOMIR)INSMIROONe AT Iteet 4Se(.f�/f7.COMFZFIE ORAVANG AT MINER AREA POOVtMD. <br /> Tw-STArF- S7 C'o�o SLI�1 C-- <br /> 1.NA}AtS ff!eTR[[Te MIIpAp/NEAIRST SOOR R <br /> Bb1R100!(1111tm" FRY. <br /> a.". •~ <br /> �r.'B.OVTSM OI TTII 4.LOCAV"OF! <br /> R;. ITAOtERtY,eivllq EMFMt1MpH/ANb NOR11T DwevioN, IOUeF/EWAOt gIF'OeAL IYTFF[Y OR TTTorO/EO <br /> GIPANSION OF SEWAOE bRIM AL BWTrMe. <br /> . b�NehMfa OVIIIIFe Alaj OCATI,/N or ALL EAeetela <br /> AND/W-Aaw V%AND WAae <br /> . /.tOrATIOR OF YVrUg VA"m RADIUM OF 0#4NIMOE[O FiTY FT. <br /> r � <br /> F. � .r II ARW •/DCN OI/L/KA lolMq <br /> IIF PRDPERry OR AbHIOrERI§'. • <br /> t I <br /> � SEL r <br /> I f <br /> ]��„ •w.Ils'r'•r „ �'�tl;� ,�-• � , os4K�loEv �G�a.d 'il E`'r �Q N 1R. ;..€ �i <br /> 4' ��a s k tM fs 51+9,fr uW � l ,+j HyiaRe i ' Irk f y�, il. <br /> fI '� ntr � �> f "�, Yi4 ��t,yy 4: i$„r„Ad dE�'.I. q r"s` ° `` r T ' t✓ ki.;;. u.'$�7! '�'rY IyMY •ai{ <br /> ,��;, i ! ..t{ � 1 _• F f !> s L�•5• I�.. S r' tw la e� A'1--d �- }'�� <br /> A 'A i- Sr.r'�tr 'f'`k a�'`.11'• 'Tt <br /> tt <br /> { ,;. i= <br /> �1'ly <br /> i j i t - k F i1 Ifil- ,YF...... <br /> { - <br /> x <br /> ... .......s. ...s..._......�-.....i <br /> J <br /> e ! 7f I <br /> i f{ <br /> ...i..........o ... . = <br /> I <br /> .........:......o.... i.....a._..E-. <br /> .. .....i-.- <br /> ...:.........: ..E....... g - <br /> i. .. ..;... ...j.. . <br /> .. ....t.. .r.....-... ! _ - I <br /> ..:......... .'r...... .. # .... <br /> -r.. . ..-.!..... <br /> i <br /> i ; ..:... i.....:..... <br /> LH7MTMrMT USE ONLY <br /> APFIip.,L,.AFe•peM BT DK•i!/'1 1- 1 F „�. <br /> --J�II�_ Arr <br /> O:eu,T..,p,9rlan/r b•e• r,T,ro I.:.r••,1e9 Br <br /> OeN.,sn•n TMP•el,a FIT <br /> O•e• <br /> a ,p D x i Y'G <br /> ACCOTINIrNa aRtYI NDN rAC1 <br /> PE CODES FEE PIT AMOUNT ItUAITED CHECXCMANF RtCEIVEO NY DATE <br /> POWIITri4IVICE TTEGUES7 RLNARgt INVOICI <br /> Or <br /> a �b 3' U a <br /> Pub.HGOM Sew.-Envtrp.173{3196) <br />