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2 <br /> APPLICATION FOR WELUPUMP PERMIT <br /> I SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL.HEALTH DIVISION <br /> —NA EAST WEBER AVENUE,STOCKTON, CA 95202 <br /> (209) 468-3420. <br /> NOX-REFUND BLE PERMIT EXPIA S 1 T AR FROM PATE ISSUED <br /> (Comp6bi fu Tri rclle) <br /> AMIAZATION IS HERE BY MAO£TO rSt SAH JOAmps CDUNrY FOR A PEPM4T TO CONSfWJCT ANWR*tSTAU THE W0W MMC MED.TIVIS APPLICATION IS MADE W COIK'UANCE wTT11 SM <br /> JOAOV*COUNTY DCVEloe7'M0ff T�MJL�/C�HA/pTER 9.1 116.3 mm Tke 9VANUAMs OF RAN JOAUVM COVMTY n�e0.Jc(7HSALLTHH ffgvMCE6,F."" 7WWNTAL HEALTH Dfvtelm_ <br /> JOE AD S&'OA.APRs / �"'-' - Y`��+J e,,t S l,C erry S12) /v"" P <br /> 9.vNFJt•s HAW <br /> CONTRACTOR J � /'?'�7S�0 <br /> C� 11&V^tS -5-627 <br /> - 11 <br /> +o,e ca+rRAcrOR 'oorJGa/a. ✓� 1, , °0 �3 GQ 1 0 v glz, c-t c. 77,0p � .HO7fi" 6 <br /> TYf�o>=wnt.4vsar; ❑ I+EIfV M+RLL feEs1.ACELtE11T wETt ❑ I+esMrraFwMio WEtt. CI OTR+U <br /> - ❑ WNTALLATIOM ❑ V LL VMTE1.+PEP-M ❑ epoes C.ONnecT ftwAwr1 ❑ VAA'"EYTRA T10m WELL I 1 <br /> CTYF*ox I'VIAPI <br /> 0M«.0 P,.b N,r. DOPTM.t»r+sER FT. F*Rar wATfA tEVEL O <br /> ❑ ovr-0RE£Av7Cf'WZLL CI OLVFTtYtaCAt vEtl/ L2X �17L DamNO <br /> RYII'-rioSO UK% rYPE OF wT1_L CO"TRUC710M ZPEM I A91OMa A <br /> ❑ MI DUrTMAL Cl OPEN uorroL DIAL OF WLT•.L EXCAVATION VIA,OF CONO4JCrOR CASINO v <br /> U Domr;s lCm wvATE ❑OMISL►ACY.Aar2E TYM Ol C%SWOMELITVC DIA-a WELL CAEiNO a <br /> ❑ pjmx .RIN.CfPAL L_!of w. DEPT14 OF 6140VT AEAt I;rECrt1CAT10M A <br /> ❑ IM"CATIONIA8 ❑OTw-A GADL f SEAL WIFTALLEIj� ❑BY IFF"UT efkAM7 WA.Uk f`3"t E <br /> ❑ FAOMTOm"a w�:.yn--A- r1�._ OPWT UM PWK07:L.J Yw N. CONCPLCrE F£bfE7AL FIYI)MULP,( y- ON. $ <br /> APPROX.D[s'TtL 7 � 8T�n eouAsfovi PWIE <br /> PleOroem CONS TTCNld7LLt O h4a"01)' MU'DFDTARY A:R ROTARY AUO£rt CAM OTHER _ tS� <br /> 11rEefEY CERTIFY 1I4AT I NAVt PREPARED TI4M As PVrATfO•r AND TnAT THE WOOK wR•I,SE DOf.E IN ACCOfWArqCE wtTM SArt jOAaIRH COUwry OndNANCEB.6TATE.LAWS,AMD RMS AwD <br /> R£Ot.R_AT/Oks Os TIK SA/i.IOAOIIRt COS74lTYr <br /> NOW OWNER 0^LJCSWSED AOENT'Y SFONATVTk CVtTIF9(S TWE FOLLOWPMO:l CUMFY THAT IN TWE PM-01WANCE oFTM WOM FOR w A" <br /> TICS'PVWA.1 10 IS/UFO.I fNAILt MOT EL LOY s'ERSO"SUB]ECT TO WOMMAAWS COUPOMATIOTI LAWS OF CAAIFOWWA.' CONTPACTO}L'S tiIFENO OR EV8-COKMAETINQ SKWATIJn CtlD'Ww-x <br /> Tkf FOtLOwWG! 'I CERTIFY THAT IIF THE rERFOPOAANCE Os IMF WOtK FOR WHICH i F'ERIfr m 16VAD,I SKAL.L Ekq toy PERSOMI ruaIECT TO VfoAnam"COMPOISATT0f1 LAWS Of <br /> CALIFOT"A.- THE APPUCANT MUST CALL:44 WtWS IN AOVA14CE Fall.ALL MDOLIPEn DI:f'CM,"AT a*"444.2.&M COLGLETE DRA.wwn AT LOwat AREA PRO%,Dfp- <br /> e—& <br /> MOT PLAN Iv....m s..w a4w to <br /> I. UAMEa OF IrrIUTs OR RDADs►/EVERT TO OR&OVHOtMO THE FROPE)[TY, e. LOCATION Of%OUi E SEWAGE DI9AOUAL SYSr(TE OR p"OMg(D <br /> 2. 0VTtPM Of TWt PV<WtRTY.OP+kI0 00.4CHOONS A►q WOFITW OtrlCTIO}F. VWA"WO.t Or SCWA@C bt8►OSAL_IrYSTfus. <br /> 7" DtR+EROKMED OUTLTW W Alio LOCATION OF AM"tETIM)AND F•R09VStO S. LOWTION OF wills v+rsm#Acws OF ONE HVNORED FWW F-T, <br /> STRVCTVFgS.INCUPOr"O COV[rED MEAT VJCH AS PATf08.DFrwtWAY3.AND WALKS" ON THE P"OPUI"Oft AD.Ou Pea pnOFV'r Y. <br /> • <br /> s <br /> irr n :.r <br /> a <br /> } . <br /> i <br /> 4 <br /> r Ln:r <br /> e..5. <br /> .r r .. .r .•• a «• •.....• • n .. <br /> w...L <br /> ....i <br /> .. r: .:.. ...«Len .L. • r -..: — ... ....... ........ 1... • <br /> i <br /> • " <br /> • <br /> VETAATMV4T US!OWtY <br /> A•►e1I..e1.+1 w.e.yre.d roy Dvta <br /> A— <br /> O+..A I.+•v.c.b..BY Dar. 1Rs+y 1Moxeadwl M <br /> O.I. <br /> 0�++.nml.n Mwne.tb+sy ORa <br /> ACCOUNT No OHLYT AID# FACS <br /> F'I COMA fort two AMOtRIT RflMTTFD CNWXfflfCA4W Ptca Et1 K OAT1ti FI3F"tISEIN4CC?%FQl; iT kUMjLIx txvMCt I <br />