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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAOWN COUNTY PUBLIC HEALTH SERVICES <br /> s ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468~3420 <br /> 01141 UIIUA L RILL RT! Q DAII IsSUIV <br /> lc..ys.n rlynf.l.� <br /> UAW- CU M V M eY PUE TO fL CAH RUAOUp COIMTY TOR t 1irTAmT .4 TbNRTHRHCT AOM eMTALI iH!lupe«OEfCHseiD.ff R/AW'UCAIIDN 1s MApE of CMIILHAHCs WIII!sAH <br /> - JOAOUfI G01/1RTv OEVELOPYENi TRLE.CIIApTER @.I 1}n-,H ANO 111[sTAHMAlHDs W CAN bApUDH COUMV <br /> .� /Ve{1C 11lALTNREFfVICER'ENVNIOMJEHTAt IRALTN ERV,,WWC . <br /> Jos AO MS'aom Arm. <br /> �,/ ^ r rA►eEt a:oArm► 1 <br /> OWrKR's NARK--Li.C.L_ 1 AOO1,F.. 0. 2U(3y./ <br />. c .. CIWNNAC70lI�i SL'� •fO1J (ll - AbOM Q 1 11 11LC 'moNo r2-O&n9A- LE� <br /> J tlCr �M10mEf�1l 3Srn. <br /> MJs COMAACTOR - <br /> .f rmbHt r <br /> : ❑eA1w w[tt ❑PerEACELAEmt WELL 13MbrfToHEM WELL r ❑OTHER <br /> .. <br /> Q IHt1ALLATNM Q WELL m7Eu REPAIR t3 C1q/aCOHmECi RErAw .:. <br /> ❑vAroRu7RLeiIONwEur <br /> _ ❑7Mr 0R-i R.P. DE►TN rump"T_R, <br /> RVpl OF Putun TOM WATER LEVEL D <br /> ;i 13 OVl-0FpRVICE WELL Q OEOFIWINCAL WELL r <br /> QCE*THRHcllorn - • <br /> L 7 [MTLNDKP UP41 <br /> I <br /> ❑ii sfpUWIlsAL ❑OA7[H SOTTOY DUL OF Vatt EICAVATION ,Ifl1- ~ <br /> I O'EDMEWI1Cw+/vAii O ORAVEL PACK/MEN OF CONOMTOR CAOM_�� o <br /> i TVPE OF CA6lHMTEEL1rVC SIN.OF WELL CA"" . <br /> ❑'p1/MIGYNACI►Al ❑OH/VEN b <br /> ❑ bECg1 <br /> OErTH or OA <br /> PRsoATKIHRAO OLIT pAl <br /> ❑OTHER ORCA <br /> 11ON A <br /> I 0�>,IOHr1oRHp OUT MALsvWIA1LEO Rr f r�.,tn 1{" OROW iRANO j..6 4 to r <br /> ' I r arutrc WAIL rl/1:Er[a Piv- QHH. CDNC,ebTN <br /> A►rEpWEsm sY bmtkm YL• ❑NA At 1 <br /> . I 11o]L LomoM CHEWIER s xmow P,f <br /> PROPOSED COM/TR,ATIIONlbplLlNO MEENott$LVD ROTAM AIRROTAM ALMER r <br /> e aTHi : <br /> I HE'!RsY CERI"THAT H HAVE P/EPARED TM/AH71RCAlION AHD IHMT 1HE WOI/L MVKL s/t1011s p ACCOROAHICs LMfN SAN bA0U1N L _ <br /> 11[o1HLAT10Ni 01 THE RAM bAO4lsH COUP". COUKTV O"OMAHCl%WIATE LAWC.AND R,xu ANO <br /> p oN OWNER ON LICETRfTD AOENI./RIOHAILNN M11Tf,E/THE HOL►p1MlO,'!CERILry THAT M TEN lsIEV-4ii--s OF THN VMPK WR W/FCH <br /> TM%!Q EYE WO2 't C 1 SHALL NOT WTIRI fRPOfvH$ Cg OpCl TO M W V4 M•/OOMF/H/ATgH UN1C pp CAt1FOEMR,'CONTIVICTDIrs TErl,eO pq M!«p,M1UryCTN1O/pM,{ <br /> * 1HR POLLOW,110t •!CIR71/Y THAT pHIR/ERpO1wIAAICf OF lilt WON(FOR WHICIL 11R$ptNAIT M IV". <br /> 1 E"a EHpLOY 1'E/EOm/ TUHR CUHP`R$ <br /> rmpwRR ArF{HC T M ADVANol FAR ALL MOL:IRRD NOP""ORf AT QCT TO WOPENA1rs COAN-MOATION LAW$O►' - <br /> • TENT�M./ir/.COYe l OM%%Wm AT to%SR At" . <br /> Da. <br /> Kell pt"IN- <br /> 1- <br /> N-1,t1MAEf OV/TMIT$OR ROAD/NEAREST to OR POUNONM TIR r Wtnr#."EU ..LOCAtION OF IIDUp REWAo!gMVfAt RYWIUI M PRD1ptl <br /> V L <br /> T.OUTLINE OF THE f*PtMTV."M OALEH/IONf AM HUM"p"CT1oN. <br /> 7.b, HMOMO OVHHT.R AND LOCATION OF ALL tXWtRM AND N,OpopD ElfrAmflON OF sEWAOs ORI'O/AL ociAL&MtMe. - <br /> ITTXTL/REC.RACLLIOOM COVERED AREA*$UCH M PATIO$.DIRVEWAY/,AND WALK/. HUNDRED TV" <br /> ?I. <br /> ONTHIEF PITY - <br /> .. . 1. I I <br /> OR AD PROPERTY. <br /> }.... <br /> 4Rr f <br /> ...s..,. s .. .. .. ....:... .. <br /> IiJ. <br /> 'E <br /> :.. <br /> F1' <br /> DVARIfLtEIT u/R ONLY <br /> ArA4Ny.1 Hw1.e w 0.,. - r A. <br /> tl�V..1,....rr..O.,eT ow. - •. <br /> h <br /> -i <br /> ' ACCo1HN11NO ORLYI AR)! FAC! .. . <br /> 1 rs C�Qsr Pq HMO MAOUNTMMI'TLD CHECRIICA/N <br /> '- TRCDVEO/Y DATE ►6MMTMowmi MOUs/T HLIR1/EI . . <br /> S ;Iget <br /> eHvvfcr <br /> pub Hf ri SMY.•Emlro.ria(IM7) <br /> 4 .. <br />