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P. 2 <br /> ' APPLICATION FORUMP PERMIT"' C <br /> SAN JOAOUIN COUNTY PUBLICUBLICHEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O. BOX 3R8. 904 EAST WEBER AVENUE, STOCMN, CA 9S201388 <br /> (2091463-3420 <br /> ROWNEFURDARLE PERMIT E)UI9E9 1 YEAR PoD■ DATE 1940E0 <br /> ICAFIPIFPE In TrbDuM1 <br /> Ap ATMN IB NENE BY MADE TO THE SAN JOAOV W COUNTY FOR A PeR TO CONGTRUCT AMMR INCEALC THE WOM MMC WBED.TM1 AAl1CATMN 18 MAOE M COMIPU,,,E WITH E. <br /> JOAOUIN COUNTY OEVEWME TRIP CHAPTER 9.1116,3 AND THE BTANOAROS OF IAN JOAOUM COUNTY I~HEALTH BFFIVICEB,ENVIRONMENTAL WE TN OMNON. <br /> f1I(JOB(AO �F>CRAANP 802 N. Cluff CJn. T,oCi P APNF 049-080-51 <br /> DwNEATHAME - � •Frank _ <1 pcr <br /> mom" <br /> F� F� <br /> CO%rR mA Western Strata Exploration In(_ADDMRRP.O. Box 1664 X1552198 <br /> IUBcoNrnAnoR AODRERR �F_�9}r(� �7 3-1 1 1 1 <br /> TYPE WELL W, 13 NEW Y.THL ❑ PEMACEMEM Wtu Fj MW 1 ❑ OTHER c . ,7 <br /> pl MOMTOroNO M•LIl I _ <br /> ❑ INRTAIJATpN ❑ WELE svvTFM RFrnRR ❑ eROIOCOHNECT RREPNR ❑ VAEOR E.xT A I)N WEu <br /> DE q,MP, <br /> ❑NrN❑R.P.Ir H.P. DEPNI q NN`BCT F1_ FRUIT WATER LEVEL <br /> RY.•E I [1A��3ROWE1 —30 Feet <br /> 13OVTOF-SFPVN`E VJFLL D OEOITO'BICN. LL p IL BORMO �+. J <br /> ❑DEIRFUCTION: 1 -45 Feet <br /> IMTp9E0 UEE TPE OF WQL PFOMBTRVCiION BPRINCATpN <br /> ❑ MOUBIMAL ❑OPEN IOTTOM NA.OF WELL EXCAVATION 8 1 /4" SIA.OF COMUIO OR CASING N/A <br /> ❑ DOMFnn ANUVATE ®a1MVFA PA A 2/1 2Sand <br /> aE TYPE OF CABINo1RTFEwVe 2" Sch 90 aA.DE YELL Cwarq 2 Inch r <br /> ❑ FVBLJCMUw%:WAI ❑mw% OEPH1 OF6bVT REM 27 Feet EFECIFICATOH <br /> 11NIF <br /> IGATIO WAG ❑OTHER GROUT PEAL MFTAMLO BY W�-E('C Y P X OROUT MUJID NAME P n r-t 1 a n r1 f <br /> ® MONROFINO 50 Feet OHDVT acA Mw D:❑Y- Im. CONCRETE KOFFrN rDNllfR:❑Yr X14 <br /> AFNIDX.DEDTN IOCKRJG CHISTER wxX ow nPE <br /> ORObEFD cONBT111KTIOMIONWND METHOD: WO NOTAW AM MTAIW w,,ER X CARIE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPANEO TNM APFLJCATION ANO THAT TME WORK WRl 6E PONE m ACCORDANCE WRH BW JOAGUIN CWNTV OFORNAHCER.STATE LAWS.AND RVMF AN <br /> REOUTATTOHR OF THE RAJI IDADUN COUHTY, ROME OWNER OR UCENIEO AOEW'F MNATLMF CM'r"THE FOILONNNG-I CMT THAT IN TIE PEIVORMMI,f OF THE WORK TOR WN <br /> MB KRYR II IBBUEO.I}TALL NOT MKOV PEROOMI eUBJECT TO WOROAAM•e egNFgFAT10N IANIF OP CAUPORMA.' CONTMCTOR'9 MNSNO OR FwCOHTRACTOIa agNMVPE CFRIIFIE <br /> THE FOILOWINOT: -I CERTNY THAT THE KRPOFA.ANCE OF THE WORK MR wpC11 TMB KRMR IS MMKD.1 BNA%EAANLOY PERRONR SUBJECT TO WOIMAAR'E CRM,,Ig"MN UWE T <br /> CAUFOMRA.(1 wNT mint Iµ1 BE IPO "�AOVAHCE FOR ALL IMGLERM IIFFPECTIOFM AT IMI AAAJSEf, COMPLETE OF AWV AT RAWER AREA FFIDVIDEO. <br /> N.n.AX v'\•� L-,.<--� S ('17- {,,�___ •M. President 3-25-97 <br /> D.I. <br /> / \ MOT MAN ID..•.In R„r.l a«I. 3/2 5 I <br /> I. RAFIE9 OF FrREETF OR ROADS MEAREFT TO OR BOUNENw THE PAOKRTY. See ENGEU Work Plan Dated <br /> J. OVTIIHE OF THE FNOKRTY,dvlNa dMewmNs AHO NoIRN OIREGTION_ LOCwigN OF MOVIE SEWAGE degBAl FYBTlM Ow Pna.pgEp (� <br /> 3. OBAEHMONED OUTL ,B ANO LACATOH OF ALL FXIETN AN FXPANSON OF BEWARE OIBPOIAL IYBTEMF. <br /> O PVCWAY D B, LOCATION OF WEU.WITH.RAOIYS OE ONE IRMORED eIFTV EY. <br /> b'TIRx-'f VK3.MCLVOMR COVERED AREAS gJCN AB PATIOS,doVEVJAY6,AND WAub. ON THE FRRKIRY OR ADJOIHIHO ryOFEJFry. <br /> y <br /> 7 I // DWARTAIT we ONLY <br /> AvvMHIr Aav RHld RT `.l MAI \ I/ _ •.- l I D.R. `� ry / I �l '1 <br /> I <br /> Air y <br /> G•eW Irwrp,lr B. OMs Pune NRpNO.n BT D. <br /> oF.,rup,Nn MygpRlon BT <br /> SIR. <br /> CHNmR.N: <br /> J <br /> ACCOUNTIMG ONLY: NDI FACE <br /> �cD� FR INFO AMOUNT R@A1TT® c11EC�/CAFM - `PATH AIIRVICE AEOUMT"WSW GNOME <br /> 2 N <br /> I ,ll l <br />