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�I • <br /> APPLICATION fOR IICLIPUMP PERMIT • <br /> SAN JOAOUIM COUan PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL REALTR DIVISION <br /> 304 EASTVOMM AVENUE STOCKMK CA 901-388 <br /> mm 415.3420 <br /> Nt)11-IiE TWILE Pm <br /> APRICATWM M NEIE EY MADE TO THE PIAN JOAOUIN COtMTY FOR A P6.MT TD CONSTRUCT ANDADA WCALL TFE Vv0W DE.CVMM-TPM APPLICATION t8 MADE IN C04VU LNCt WffH SAN <br /> JOAOUIN COUNTY mopmeff T"IA.CKMMM 0.X,til1 t 15.3 AND THE 6TANDAWO OF.AN JOAOUMR CMWry PUSIJC MALTH.ERVIC".VARPIO►MAENTAL HEALTH DrAMO►L <br /> JO.AOOIIE,..IORAwu r , �cyi1�GI'[>r Lt•r .ffh c4 N(1 l�'Ip4r etnr �61� rwletd�Ar+w <br /> / S'Ar) FizjnuS(b C �' ro.S <br /> MINFRI NAM l/V1ia17 Ptlei�iC l;UllIuC1Ll CcmpgwY ADDS. Olt I 40'kif f i zei �'!n Eli +�, <br /> E►21ti1 �tC _ —�- A,, ..1777 9Ofelho �+: #2G•Cim, <br /> CONTRACT" Sig 9`1lr`�YS$ <br /> CONTRACTt c, ►� ret C!t ti Y 5`!( 5 (!'> RiONE Sri` -. c?(r <br /> .U.co*M=Tm GM 1,01 k 1 Il i P75 E �c'S ri5i ADOWN <br /> TYPE OF wELULnMr (8;Newwe L ❑ wa+AealetT wet ❑ mmerowNu wa1 rr oTli� �(rYL10170 y1 'I t'Z rnx <br /> C3 SI. t`✓� <br /> TALLATIDM ❑WRL rm"m Farom D aow"mm I m T~ O <br /> �) vAPON • <br /> rnrUM4 C ON.ww❑R.P+ Hr. Daft/PUMP WT �� PT. FwarVmTmUrA& O <br /> rr"q OF"A" ❑OLIT 01 iE#1ACE Wfi1 ❑ own"mGAL V L. ❑ .OL.OM10 s <br /> ❑oe.TlweTloN: <br /> A <br /> 911M mi w9m DIA.OF MR11 LXCAVATON — 01► IA•DOF CONDUCTOR CASON D <br /> ❑ .MUST"& DDPS.oTToMI �( .Ifyh, <br /> dL aA of wt11 cAt.l. <br /> ❑ O0.lHTIClFNEVATE ❑pRAva►AtyC1SRE ;T-3 �.��u( TYPE or cA.woArrsLn�e <br /> 13 rV.uc/MtrNicIPA1 ❑DIEVEN Dt#TMOf010tJTSEAI ,:7 SPECIFICATION,•l�+C�1t C>rl>Yt{'itr N+ �I• i►tfC:t�`rf <br /> ❑ ■SS.ATIORMS oTTPPi>f1 GROUT MAL MNTALLMD w C.- .ROUr.RA.ID N^h* E <br /> LIONFro'tQ( N"o j O@KKJ T"AL PUNIPWD: ❑Y. C3 P. COM Pan PWWAL Ory OII.1Ht O Yr LJ N. s <br /> .,�.3 LDCR.a eNerrel wx Tovt F?E 0 i ►I' }� : s <br /> APPI.OX.DsrrM <br /> PROPOr®CO?f MAoCT%"Lq%.L11MO IMETNOD: MW POTARY A.1 PO'TARY AUIJ — CAUL OTMM <br /> 1 HE�71'CERTIFY THAT I NAVE FIE►ARID THIP APRJCATM"AND THAT THE WOW WMl of DONE M AGCOROA m WRN.AN JOAQUIN COUNTY ORO.IANCES.IMATE LAWS.AND RL►M AND <br /> el IN THS pppop"A"M Of THE YMMK FOR V**CH <br /> P94MATI M!OF THE.AN JOAOUId COl1P',YOM <br /> . HE OWNLR OR UC M W AGOWr*.IMiATUPE.CS1RMit THE PDLI0MI.1.+N TRACT Y THAIMf1O OR N� IO <br /> CONTRIICTINO ONATUM CIRrlFW <br /> THIS P£MMT If MUM,1.HALL NOT EURDY}91EON.EURIECT TO WorA MAY'S coMPOMATWO L KWB OF CAUF OWW1 • COMRACT'OR'• <br /> THE FOLLOVAM: 'I CtPMFf THAT IN THE PETPOR.AAHM Of THE WORK FOR wWo TNI.POWAT K MSUm•1 04ALL PO4-OT 015 W .U"=AT WWOOM MAWG�TION LAW.OF <br /> CAUFOMSIA.* TNS APPUCAMT MINT 34 M ADVAMOE POR ALL REOURm WNW4P 1101..AT R2 O 4..-.4... OOAMLLrM OMM1M'10 <br /> ATIM <br /> 041. <br /> N ,Pjr_ <br /> crow M.rA..FI. 'b <br /> 1. NAME.OF WTTdM 011 NOAO.NEM W TO ON SOUNOM THE PROF""' 4. LOCATION OF NOUtE*MAWDISPO.AI IIYE IBA OR PICPOlD <br /> .AI.Y.TLM.. <br /> 2. OkrrUAE OF THE PIIOPIMr.ON.I.OIMfMTH IONS AND MOR011lCTtON• DL►AHW OH OM.SWAM Ol O <br /> 1. D.+It►g10NED OUTUNFS AND LOCATION OF ALL 0OW"AND PROPOSED S. LOCATION OF VIPER WITMM RADRM OF ONE MUMDIED WrY FT. <br /> tTRUCTUM.INCLUOMM COVERED AFZ•;AS 9LICH AS PATKM DIWLWAYS.APC WMM. ON THE PRDPlRT1'OR ADJO.MN PRDFUM. <br /> SACK <br /> T. _.: MAP ON _: j.. <br /> .. ..........�.... .... ...... <br /> .......... ••.•I•.• .............. • .w.l..u..�.•.•�....�.v..•...1......i......:....• •� <br /> OWARTMM UN*MY <br /> Z r'� AM6 <br /> AP..r1Men AM.PId.T <br /> MY <br /> o..r..wn b....U.n 01 <br /> ACCOUNT.RO ONLY: AW PA" <br /> Pf CODES Vu wo AAWLWT PWAT SI c"WK,ICA.H R cu%lm•Y DAT[ lmwm wlmt"Nou T RR>IME1 .IV'OIL'i <br /> � ,� wpbs wb'85'8 8661-V0-? <br />