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10/23/00 MON 14:41 FAX 1 916 861 0430 SECOR-SACRAMENTO U002 <br />11 -CS -1997 1 . SSPM FROM P_ 2 <br />APPUCATION FOR WELL/PUMP PERMIT <br />SAN JOAGUIN COUNTY PUBUC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DMSION <br />304 EAST WESER AVENUE, STOCKTON, CA 95202 <br />(209) 4sa,U20 <br />R4W-Rfi01tD461E PERRIT UpMES I YEAR FROM NATE ISSIND <br />m m lets b TrTfacew <br />APF11CATION IS 11E11 UY LADE TO TRE' OAN JpAOLnN COL4RY FDR A VOUAT TO CaNvrgACT Aw OR Af9TALL THE MIOw[ OE9cw9EO. TLS APPUCATaow m SuAnE H COHPUANCF WTTII 9AN <br />JOAautN COUNTY OEWLOPLLEMr TT'TLL CNAF IEN 0.1 115.3 AMC THE 9TAtNOAF09 Of SAN JOAOUTM COJWr/Y MOM HCALTH ��a. ENvw )NmuwrAl HEALTH OmmH_ <br />roe AODAE9atOn AFT1/ 1 ln/ _ pp e G.-s� crrY _ L c2 Cwt ; ff FAME U- AASH& a`I Sl q00 <br />DWNE7T9 xA►1E G It 2vvT ACUFWM9 i 1-7 5'CL2�iGL�r 5'L-- Ed o[� Dr RowE F <br />Tru <br />coNcYOR 3o u r� t t u,, J.,scn <br />AwcvtrhAGTprt5��ry1 U.17 019 <br />dr., <br />iYfl K I]�NEu/v.rtL� Q IWRACEMiM VIM❑ tAON�ro■Ot0 w41I <br />❑ MOTAUATiON ❑ WELL DYSTrM IWPAIA ❑ CRp a®COUNWT WAIR ❑ vAtpft "rpAc.'nOw wFYL , <br />❑ H... ❑ AeP•ir Ham_ DEPTH PUW A'LT R. Fahr WATER LLvCL O <br />(T W f OF PV04r) <br />❑ OUTOF-sE11vLCE WFU ❑ OEOP"MCAL V4U+ ❑ POq samm ■ <br />0 OESTRvcT1ON <br />IwTENDED U6[ <br />TYPE D. WELL <br />t0N■Tw1CLrON_Ap0CW=AIT10Na <br />__. _ __ <br />A <br />❑ V4MSTtt[AL <br />❑ com wwom <br />STA, Of WELL aCAVAUM <br />A. Of comnwn w cAarwp <br />O <br />❑ 0VU0Tcr'%UVATE <br />❑--11 GRAM FICKINZLI <br />n•rE OF cwtttNysYfEUO��t�Yj <br />Ou, OF wpx CAF YI <br />_ f1 I <br />p 0 <br />13 PVOUCAaVU CWAL <br />rIJ OMVEN <br />WrTH CF OAOUT SEAL 1. %1 �1`1.� <br />spranc.T. <br />0 1910a0ATw-W-4 <br />❑ OrHFA <br />6AQ[Pr SEAL 1 4TALM 6Y VV C`r� X <br />OMLR 9RANO RAN! <br />A <br />❑ UONiTOmmq <br />GQMLTr MAL PIMPED- ❑ Y— ❑ N. <br />COt.1CnGTE PedesrM. R•' DR/L,L01! �../ Y� ❑ Ire <br />S <br />Af7•SOx- ffw tw _ � _ ILKXbJO Gfrt�LFJt EOXtSTbvE �E_ a <br />�obs><n cvw■TRUCT10w7DRtUAIa u9TN00: L UO FOTARY AM F AtTt' V/ ALDER cAOLr' OTHER <br />I HEREVY CETtTs'Y T1+AY T UAVC PKPAAfb T709 ApPLYCAT" AND THAT TTtL `A *ILL flE DOW* M ACCOMAWCE w1TH OA- JOAOUfM CMR -TY OAOPIANVtP, rYATC LAW C. AND :47[.09 AHD <br />PEGVIATION9 Oa THE PAN JOAOUrM COUNTY- HOME OWNER Oa LTCEW4W APOWS StCHATUAE CEPT1pEo t11E "X.LM-lNp; '1 GTRFtf't THAT W THE PEpTaaAA►K{ OP Tt-K wiUM fog WHICH <br />TIR9 P"mrT r9 caet7F - 1 031ALL HOT EMKOY KP40N9 EtRLWCT TO W*F4 AAWS &AAPFx■ATfOw LAWS OF CAL WOMMA.' COMTRACTU" H491L0 OR Ov6+^Oten ..CflwO RIQNATtTREE c4A'rx,£e <br />THE F0LLbwING- ' I CERTLrY THAT IN THE PEF41ORLJANCE OF TUE wows FON WHICH TTnA Pffamt t9 19Ar1ED. T RHALL WPLOY PUUPVtA lnl1UECT TO riOltpAra (;vl■rvrranvw tAWr OF <br />CILL6Dt.I CA■tY N T cAll z1 HO111■ a Aw■wc9 sat ALL REOtatED OL■II'(>:TK71e• Ar Rarr1 �tA�•12>t. COLrLLTE ORAWDQ AT LOOICA AiW-A. RIO <br />1slgr.aa x%) 7aN� <br />OLOT PLAN go-- t. Banal lay ' t. - <br />1. NALAE9 OF t1TPEET9 Oa POAm NEAFEeT' YO OR oOVHOAm THE MCf"rY_ .. LOCATgY GIA HQIJ9( aWAM 0WOftAL ersTW OR P1CPO9fD <br />2. O(JTLME or TUU POOPCWY. QMNO DIMENf707-9 A"O M" 01KCT704- 0MOM ION Of *MACE DIVOXAL W9TVWO. <br />7. a-WN®et1Eo cvnjwf 9 Amu LOCATOR Oa ALL C&STTNO Awo vrvvaLn 9. LocaTTow of WEMB WFFICw NA0R19 OF OW HVNEX" 9—Ty FT. <br />t:TWXTVl%& M CLUOrNO COttM0 AAfA9 6T7CN Aa PATKM ORVEWAYH. AND WALKS_ ON T1E PTIOPFRTY OR ADJOPCM PPOPKR7'T'. <br />. .. ..a.. - '•...._' .. �... ..I b-.- = ¢ ...�.................. p.,. . _ _ ...w......e-. ..�. ... j.. .�....i ...e......5.._. i.... .t. <br />. .;i... i <br />O.a.A Y.■a•t%- <br />w.yw <br />baAR mmy Lf.R tmy <br />�. lD ZOv -„0v <br />6J <br />LM■ <br />Pug. Heatrh SAN. - EmNO. 173 019'7) <br />s <br />