Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388,445 N.SAN JOAOUIN ST.,STOCKTON,CA 96201388 <br /> I209I 4683420 <br /> NONREFUNDABLE PERMIT EUPIRES 1 YEAR FROM RATE ISSUED <br /> rCNEp6MS IS TFgUeRMI <br /> ARVLATgN R MXE fi MAOE TO THE SAN AAWIN COIMPY FOR A FE SSAT TO CON6TRUCT AAOpR IMEINL THE Vg EF(MESAHMS.THIS ARLICATpN I6 MADE IN COMPLIANCE VMX SAN <br /> MAWM COUNTY CEWLORIENT 1 <br /> 1TLk,CHASTER 8-1115 3 AND THE`6TANDAMS OF SAN IOASLM COUNTY MU HEALTH SENWI 119,ENYYONMEMAL HEALTH gMINOK, <br /> Me ADOR6MOR APIA \L,�W 9\L,\\y.' `COgO .1 \ OC\L.',O� ` PARCEL� <br /> _ DWMER'6NAME�VR-� ���C\E�\tea ApppE89 \l➢�je1LLY�`�'pL�\\�`'�qp ` gpXEl4loS•\\30 <br /> CONTRACTOR v\`V�yQ`F`SFT\ CyCt\�� �ADDRES6\\.JV \U.O C�MOYINA LCB \b\ PIIONEFyb�aA�3� <br /> 6U0 CONTRACTOR `\A,,l MDHES6 ICI RIOHE I <br /> Y TYR DF WELLhVMP: ❑NEW wII1 ❑1ENLACEMENr KFu ❑MONrt4RM0 WELL I ❑OTIRfl <br /> ❑MBTNIATpX ❑WELL SYSTEM PEPA, ❑ ( <br /> CMSSCONNECCcT,,LLREPAM ❑...N.1� I <br /> ❑N..Nrw, FLA. MPH PUMP SF)aLFT. FgETWATERLEVEL ZYQ -- 4 <br /> fIYR OF R1MM <br /> ❑OUTLFEEMN E WELL ❑GSDFHl.AL WELL I ❑ SOIL.NM S <br /> _ ❑CEETMCTNN. 6 <br /> IXTpMD UFE <br /> "NESI CONSTRUCTION SAMOA A 1 S 1 A <br /> ❑MWSTR,M ❑OPEN WTTMA OM.OF WELL ESLPVATgH IC,L MA OF CONWCIOR CAEMM O <br /> ❑W..A,NMVATE ❑ORAYSLPACK/LEE TVFE OF CA&NG/6TEEVPVC OIA OF WELL CALNL O ` <br /> ❑FUSICAIU.S.AL ❑DSWEN DEPTH OF SPOUT MAL AFfcwATTA N E <br /> ❑NWC.T,..,. ❑ORDER 4MUT 6EM METALLED SY 4MUT SMAND NAME E i <br /> 11MONrtOM1NG {� SMN,-6EK wMRO:QV- QNc mXCRETE PEOFSTALeYOMUFR:QY- 0 . S <br /> ,PPgM.CESATH aVn' LOCKING LOSTE.eO S,BTDVE E <br /> MDgFp COXBTIIUCTNIM .11THOD MUDMTMY AM FOTAA AUMR CANE OTHER <br /> I HEREBY CERTIFY THAT I NAVE NOPAPEO TW6 AFNYAT..AND THAT THE.WILL N SOME M ACCORDANCE WRX SAN JO.S.COUNTY OTOIHANCE6,STATE LAWS,ANO NAL..5 <br /> PEGUUTMNS OF THE SµMAWIH COUNTY.IpME OWNER OR IICENGED AGENT 6 SWNAT CEATIFNS THE FOLLOWERS;'I C 11 THAT IN THE FERTORMAHCE OF THE M ML FOR NNCH <br /> OY PERSONS 6VBJECT TO WORIIMAX'S COMPpSATNIX 1AN90F CAIIEOMIA'COHTMCTONSXIE OR.A.STRACTXW6CNANRECERMIEB <br /> THE FOLLOWMQ:—I CEATIFV THAT IN THE P4WOMAAXLE OF THE WONS FOR WHICH THIS PERMIT IS ISSUED,1 SHALL FMROY FEASON.eW 1FOT TO W ENOMML'S COMFfNSAMIN LAWS OF <br /> SlPrwf CALIFORNIA. THE T1ME •aAT 13W1 �COMPICTE..AT LOWERANNA PRONOFO. <br /> V1 <br /> MT MN 10.ry w htlel EPY. _ <br /> SOR MAD6NFME6TTOORSOUNMNGTHEFWT... E.LOCATNMMIgUK LSMiEd SWTEM. OR AOPoMO <br /> ]. OVTUNE Oi TXEP Shl.A,41VM A.N.1 ALL <br /> ANOXOMH gRECTgN. pSALONOF ELLS Wg6Po SP16YSRON <br /> pMONEO OUTUNFS AMO NE AANE S ALL FAI RINGANOA WAI., IN THE INOFWELLS WRMM MgU6 OF ONE XUNp1E0 FIiTY R. <br /> STRUCTUMES GCOVERO AIEP66VCX AS PATIOb.O EWAY9,ANO W/LLRS. S. <br /> THE F1pPERTY OR ADJLIINING PWPIXTY. <br /> Q <br /> D <br /> EST (� SPS <br /> UI SEP 2 G 1995 <br /> SAWSTAS <br /> pr ME. Ll <br /> Q.H.PANwI er `�^'�Pune ImlXutwn erg 't.1L'Y�i."1.7.x` I Y oH. r 4 <br /> Ow.,S—LW.eB.n er <br /> C.— <br /> AL <br /> a DNv: <br /> FM INFO AMOUNT RWITTEO CXEC (CASH COVED BYAre <br /> 0;. 3�7 <br />