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APPLICATION FUR WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O,BOX 386 304 EAST WEBER AVENUE,STOCKTON,CA 95201386 (( <br /> 12091468-3420 <br /> NDN_ REFUNDABIE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> (COMPIfI!In TTbrWlI*I <br /> AP/FICA7ION IN HEFIE BY MAOF TO THE BAN JUAOIRN COt1N1Y FOR A PEAUIT TO IC CONBTRMT ANOATn PNST ALL TNF WORL MCCRISED.THIN APPLICA71ON It MARF IN COMM IANCE W1TII SAN <br /> JDAOLRN COUNTYPM <br /> DEV[LOENT TIT"$CHAMEA 9-11 19.3 AND T-IE ETAND/AFVIT OP MN JDAOUIN COUNTY PUSIIC HEALTII 6EnmCES.ETNV111DINMENTTAL HEALTH OIVINON. <br /> .roe ADDRESMr.APNJ ��� ( /a2 PE/U 7 P PIAn"1 S re,ck--T—d-/ PAPCEL EIZFIAPN/_ <br /> OVAVFR'S NAME�y � <br /> COM RAf TOR Atjj2rkC <br /> K 12 C _ADORERS ��-+1bJYO�,TC�i `C�IJC PNONF f.�L1L9..117 <br /> SUN CONEMCTOR !'l AOOnESB `� " — •� 5— <br /> �Of YEFLIJPU— 0 NEW WELL ❑REMAIEMENT Wfu EF- RO <br /> El MONIFORNO WELL F y OTHER <br /> Ll RNSTM U1TlON ❑WELL 1-1? 13 RFIAM CSS CONNECT RfeAM Q VAPOIL EXTMC+qN WELL/ <br /> Q r <br /> J ❑N�.r�apFN. N,P, 1 �/,Ja <br /> 41 Y OF P ' III-.PUMP SET�FT. HRB7 WATER"E'1EL <br /> k7i <br /> ['/� ❑OVT-OF-BFR VICE WELL ❑p[OAIYBICAI.WELL P ❑ eWL BOIWro S <br /> OEBTRUCTION: FJ —__ <br /> INTM.m U$lj TTFE OF WELL LO fiPVCll0/1 BPECIFIClLROMS A <br /> E❑-I I�Nb11ETRN, ❑OFF.BOTTOM DIA.OF WELL EXCAVATION_ _ DIA.OF CONIDUCTOR I-RIM O <br /> Ol DOMESTICA'.1vATF ❑OMVEL PACK/BILE-__ T PF OF CASINOMIFFI RVC OIA.OF WELL CASINO O <br /> ❑FUBUCIMUNICIPAL ❑DRIVEN DEMII OF GROIFT SEAL SACIFICATION 4. A <br /> ❑PRICATNOWAO ❑OTHER OIIOUT BFAI IIIRTAt LED BY GROW SII.AND NAME FFryry E <br /> ❑MONTOAMO nROLIT.-..RIMF'FO..❑Y— ❑N. CONCRETE FIDESTAL BY DRILLM O Yr [IN. <br /> S <br /> App"K.DEPTH LOCSINO CHFNTER SO%)STOVE TIFF S <br /> PROPOSED COT/STRUCT)ON/DNLUNO METHOO:MUD ROTARY_ AIR ROTARY-14,^MroER CABLE OTHER{ <br /> 1 HE9FBY CERTIFY THAT I HAVE PFWPAFEO THIS APPUCATION ANO TEAT THE yooM WILL WE OONE M ACCOMANCE WITH SAN JOAOUIN COUNTY ORDINANCES.STATE LAWS,ANI Fut FN AND <br /> FEOIRATIONS OF THE SAN JOAM M COUNTY,HOME OWNER OR LICENSED AOENT'S LIONAIURF CERTIFIES THE FOLLOWPM;•1 CERTIFY THAT M TIE PFNOIMAANCE OF THE WONC FOR WHICH <br /> THIN PEFMER IS <br /> ISSUED. <br /> I 2I4Al1 NOT fMT10Y 9FRBOINS SUBJECT TO WaFSMAN'S COMFFNS ATgN LAWS OF CAL¢ORNA_"CONTRACTOR'S ERNNO OR SIN COMMCTINO pONATURE CEITTIFIFS <br /> TNF FOtLOVAM: -i CERTIFY THAT IN TIE FFFFoRMANClE QQQO7yyyy7((F TIE WOR:FDR WHICN TINE Pf.mmTr IB)BILLED,1 SHALL EI.IPLOY FIRSONS SUBJECT TO WONO.tAN'B COMFENBADON IAWF OF <br /> CJWFOIMSA.' TFiAFR�'FINT=ALLN HOUR% INA !bR ALL RFOIARm IRBPRQRONS AT)JOSE �Cf 11f�C/�/FItlT!bMW.NO AT LOWER AREA f710V10EO. <br /> NN..dx JJ\\�L J -/_ i/!, <br /> PLOT"."Id.vr ee S.�cl EOFI. le <br /> 1.NAMES OF STAfFFB 09 ROADS NEAREST TO OR epUNDI N0 THF PTIINFFIrv, �^ 4.LOCATION OF HOUBE WWAOE DIarOSAL eYB7FM On m,nrIm.En <br /> 4.otme E OF THE PROPERTY,O"V1MT OIMFNSgNS AMC MOM"OIIECrf'N. EXPANSION OF SlWAOf OIPRSAL SYS?EMf. <br /> M <br /> J,DlNSIOMED OVTLNFB MND LOCATION OF ALL fXMFTT p ANO FPIpPOt1ED S.COCATMN OF WILLS NTTHIN MONS M Ohl HUNOnEO TETY FT. <br /> STIMICTURES,MCLVDINO COVERED AREAS SUCH AS PATPOS,DFUMYAYS,ANO WALT S. ON TPS[FRM MY OR AOJONAM PN7NFJITY <br /> I <br /> av <br /> fu <br /> Me <br /> cosv,*vc.,7&z- too " ..:. .. <br /> I <br /> FrIB1aC'I'E.RI'.T?';. <br /> "ILj A{ •,FA,LTi ' .'.'S::i <br /> DMAn IMMI USE ONLY <br /> AF Ae —Aw i d SE DEIFIth <br /> a.,A 1.npe.11w.eE wm.In..cuen ey _D.I. 2 <br /> be.IRitNn L:M.ell.n Ry_ _ ---, _ OFN <br /> c.mm. <br /> --Imo ONLY. AITL/ FAc.I <br /> fE CCOEA fEE INFO AMOUNT REIAIITFD C JfCAAH`i RECENEO SY DATE M MAITNIIINVICF ARGUUT NUMEM I.VOICE <br /> 5 O ' 0101 911 f4 0/0 <br /> q <br /> Pub Heelth SerF.-EnOm-173 M96) <br />