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-PP11C1*N FOR WEWPUMP PUMiT <br /> SAN JOAmirx tomm Wituc HEALTH Sf}yms <br /> ENIVIROMMENITAL HEALTH DIVISION <br /> P 0 BOX 31& 446 Ni.SANS JOAQil}K ST. STOCXTOIL CA 9W14Q8 <br /> fMlWIELWma WW—T min I rail FUN OATF swim <br /> ;opdicstion is here by made to the San daepuin Cau+ty for a petit to sanatruct ardor Install the work described. This swifeation is <br /> ,edc in COpliame with San Joaquin qty OveOEqplo,t Titte. ampter 9-1115.3 and the 5tsnderds of San Joaquin County Public health <br /> services, Envirw,meatal health Division. <br /> :oD Address/or APMA -1 & 1 i "city 1r aerGet Si:e/APMs1 <br /> 1_ <br /> �++�ers flame crll!�e„ � <br /> ir 0 s <br /> Addrams Pt, e 0 31 -4860 <br /> .anrrstier Address Lids Phone A ��a fZ0 <br /> D 7 Bo .�]! 5719 <br /> • iof O <br /> :L� contractor '� Ys M <br /> Address, , Pnonr ar C8 <br /> -I" of VEULPeE a NEW WELL A JEP',ACPWJIT WELL XFFJNITOR11Nf WELL s MW-1 JKtTNER Oct 5.4e mar%) <br /> DESTRUCTION(2) .t7 WT-OF-iERWCE WELL n 4ZOFNYSICAL WELL �__.____ n Soli.(MING <br /> II INSTALLATION p WELL STWIP REPAIR 0 [ROSS-i01ifIECT REPAIR n VAPOR 9MACTION WCLL <br /> N D New a Repair fi.p. MTN PW UT- L42SWL FT. FIRST DATER LEWL uA"tA4tdeA <br /> .TYPE Of Pf") <br /> MW--% 'get. qf- %b/ <br /> _IIFENOEEIlaSE 71T!9F�fi1 [�_�i1NIGffDII S� fiC �T� <br /> i7 INDWRIAL Q OPEN wtTOII DIA. OF WELL aCJIVATION DIA. OF CONDUCTOR CASING <br /> i; DOMESTIC/PRIVATE Ll GRAVEL PACK/SIZE TTPE OF CAiI71C�>•VC DLA. OF WELL CASING <br /> ;1 PUILiC/m MICIALL 0 DRIVEN DEPIH OF GRWr SEAL SPECIFICATION <br /> iI ISRIGATICM/AG xOTNIA uv-k►poU)N GACUT "+SAL INSTALLAD ST MROUT YRAND NAME <br /> [7 MONITORIN4 GROUT VAL 7two.. Q Tat n No COMCR$Te PEDESTAL RT DRILLER: n Tet C No <br /> &PPROL OEM LOCXING CHESTER /OIt/STOVE PIPE <br /> E 'ROPOSED 00881 CTIQIlID INETMom NUG RCTARY AIR ROTAity— Qw— cma—OT118R�"Ne5StAve G�O%4+i%% <br /> � <br /> I lierelw certify that t have prepared this appl.catior ad Chet the mark mitt be done In accordance with San Joaquin Cav+cr Ordinsncss, <br /> Mate Laws, &-A Itules and Regulations of the San'Aawpin County. Htal* owner or timwed agent's signature certifies the toLlowing. "I <br /> certify that In the performnte of the Worst for which this pa Ot is issued. t shalt rat esptoy persons subject to"VGRIO MIS CONPENSATION <br /> .ays of Califarnim.e Contra"or's hiring or sub-contracting signettre certifies " faltemings • I certify that in the performance <br /> �f the :work for Which this permit is -*sued. I spall emiptoy persons Subject to WOftOAN'S G0109111SATIOd Laws of Catifomia." THEAPPUCiNT <br /> MUST"LL 2 Nott AOVAtNU FOR Aim INEl:fmIM.AT=481-301. Complete drawing at lower area provided. <br /> ii / f/ �T Title <br /> i <br /> rte? C AT11 i <br /> 1larE wlLr <br /> Applieatfon Accepted ey r• Dime 944—// Areae <br /> Grant Inspection Ly Date_ Pump Inspection fIy Date_ <br /> aestTuetian InSOM114n sy Date—Cost alts: <br /> ACC041IETIN GIttr. Alto FACT <br /> MON <br /> PE CDm tum <br /> A REgI1T® GiCKaiCAfit 1Ms 1� BATE FEW p>i 01MOM 3001 Ova <br /> ._ 3507 9 q- Lh <br />