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S-13-1997 2:2SPM FROM P. 1 <br /> APPLICATION FOR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PURLI(iHEALTR SERVICES <br /> ENVIRONMENTAL HEALER DIVISION <br /> P,O, BOX 388,304 EAST WE8EF2 AVE*E. STOCKTON, CA SEMI iaa <br /> (7091469-3420 <br /> NON-REFUNDABLE PERMIT ErMES i YEAR FROM DATE ISSUED <br /> IC.mP61.1.TT'vRegn <br /> AGJFCATION M NFRE 6Y YAG(TO T M SAN JOAOVM COUNTY FOR A OfN.IT TO CONSTRUCT ANDIOR INSTALL THE WOR, <br /> NApTEfl 9�111S.31Np THE 6T.WO6CPoltfO.TINS AICATgM <br /> N Ift YAOE CONvLIANCE WRII$A <br /> .bAOUIN COUM[Y OEVFi1IPMEIRTRLECCSANJOAOVW COUNTYAJ�AUCIW/ TpF,N Se'Ee,ENVPONMENTK HEALTH 0M00.. N <br /> NB AOORESS9R,A/V,N�/ /� /� - / ��I��AODO OF LYJ�) CIFY S 1 Oc-v-� PARRCCEELL 8.$ ALV. <br /> oWNER-q NAUE <br /> CONTRACTOR //f'tT ApD ..JZ33 F.7GEE(JAs��7 ✓�' S'–' yy,,�� t/ �j / <br /> NB CONTpAGTOR AOnrr[,68 UC. <br /> /� PHONE <br /> TYPE OG WELLIPUMP. �.NEW Wcll ❑ RFVIACFNFHT WEly �uONOOeINR V.TIt/ 7 <br /> ❑ OTHER <br /> ❑ MBiKUTRTI ❑ WElL 8YBT1:T1 R[C/VR ❑ CPORS{ONNfCT REPAgt �VAMgE%TIMCTION V.ELL. <br /> N°`r �'I' M v. OFITN <br /> It <br /> RPJua eFT IT. "NOT WATER LEVEL <br /> YFE OG q/4V1 �— <br /> ❑ OVT-OFRFRVME WELL ❑ O <br /> oFOn1YSKK WELE l ❑ W1L ROmup ' <br /> ❑OEc .M,ON- SVL ,/ R <br /> WT ENDED USE TYVE OF WELL CONGTROCTION SPECIGTCATN)N. 8/IC-1 WOVHTRAL ❑ON OOTOY DOElkTOF WCFTL EOX/U([T WEEITNgYN <br /> 000STC ATE ❑GAAEL RACKIC OF CONNUTOR C_VA <br /> M0 „/T <br /> — <br /> AO <br /> ❑ OF ORRlR OF CASINO <br /> RRfATKN/Ao ❑OTMER F%TAmm R <br /> oRUO <br /> SfjL1,MlIiALLFTJ IY NOW BRAND NAMF <br /> NOMTORMO / GvM RDVT mwN E <br /> O <br /> pv�Y� ❑N• CONCRETE VEDE6TAL BY DWLLfR:❑Y. ❑Ne _T <br /> AAAROI.OERTN /// iO LOQING CHESTER moxlnT0VE N <br /> 5 <br /> mOPJSEO CORtTRUOTOR/dOLUNO YETNOD: MUO pOTARY AIR NOTARY AfKGR CARL{ OTHER <br /> 1 HEREBY CERTTF`/THAT I IIAYE PREV41EL1 TNIB IPR.ICATI[yl ANp TNAi TFIE WOFSµ,LLIII DONE N ACCORDANCE WT{N t AAOUN COVFrtY DAONIANGf9,8f• <br /> R TIONS OF TNM SAN"AOUN COIN . NOME OWNFR OR LICENFEO 4 EM']RH[NATURE CERTNI[6 THE TE 11WG.ANO RVLE6 w0 <br /> FOL(DWINO:'1 CERTIFY TNAi IN TME KWOwANCG OG THE WORE FOR w N <br /> IAFO.TNIR PEIWIT Ri I98UE0,1 BHAI,I NOT E1040Y VEIISONR BURJCCT TO WpIgYaYa COMRfN.STON UEYB OiCKSOOMA" CONTRACTOR'S H1RFp OR W18�COMMCTwo S,..ATLINE CERTRIFB <br /> CWE POEL WHTI -1 CERTIFY THAT IN TILE PfHFORYAFICf OG T11E vglt/OR wNICH TNR pEpaNT li IR11UfO,1 BHAIj fYVLpY IFRSONIJ gUR.IECT TO MIOR.AN'S ,OMAEK.XV.N ,,OF <br /> /HE�a_P,(wp_yART MUGT CALL]/HOUR.IN AOVARC[tOq ALL IIFOW[O rN..GOTgNt AT fret,.QI.LT}, COYRETE DRAWING AT LOWER AW.A P1No1,EO. <br /> ab..d x�//•'r/vH '�� TRI. �Z-f�i1TJcST' D..• 7 GLS <br /> RLOT MN tT..re Bawl Ra.l. 'M <br /> 1. NAUF.Of STREETS OR ROAR 14"REST TO OR ROVMDON THE I KJfFRTY. A. LOCATION MOIRE SelNAOE O18FTJRK SYSTEM OR ITOIE'1SED <br /> :. OVTtnM OG THE NOVETY,ONMV NMENInONG AND NORTM pRECTF)N, EIRANRAN OG BEV/AOf DfBWBAt"ITEMS.]. ➢R.EN84NE0 OVTI.INF.B ANO IOCATw)M OF RU EJOSTRIO NO RMRTBEO .- LOCATION OF WE qWTTfRN R/.ORJS OF ONE NVNpI{D�Ty <br /> GTAUCTVRES.NCLUOINO COVfE�D AREAS 6V CN AG PATWY1,MIO A'S,ANO WAl,e. ON THE R KRIY OR AOJORn1q IsppsnTy. v R. <br /> D..."T USE ONLY WRO <br /> AmM1e.rlm Aeeetel By \ GVl Ow• I O OO Mr� <br /> a•,A I..�.�—.eT L �dM.�—n pJ� D.I. Z 1 tl0 �p M�HaA BT oN. <br /> o,.rnNrN+l...mnp.9y �--� 2Z QrJ <br /> ACCOUNTIMO ONLT: Alpe FACF <br /> n COOED FFE INFO AYOIp F RE]VITTEO CNECKIFS6N I BEGAN"ti O.TE Pf16MR/I90RCE REOUEGT NWIER INVOICE <br /> iso �6�. vo 0o S� 5 cY DOz Z-g2 rl <br /> .pub.Health So".-Em ro.173(31W <br /> SI o° <br />