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ura �r <br /> APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)466-3420 <br /> NON-AEFUNOARLE PERMIT EXPIRES I YEAR FROM DATE ISSUER <br /> 1 e pkle M UIPIIIebI <br /> FRICAT*N M MAX BY MAGE TO TNM SAIF MAOWN COUMY FOR A FfPI.NI 10 LONBTRACF AAMM WSTNL TNM N91K DEWNBED.THIS AFNCATION 18 MADE IH COMn1ANCF WMI6AA1 <br /> IMICA W,N COVM'�Y//D)�EVEWIRQ/M1 MM C/HM-yE�R BJ-I 115.0 AN/Dy THE STAND.OF BAN. .CUN COUNTTYY/RAIM HEALTN E.E..E.R0.EMA1 RMT.gNB,ON. <br /> WNEP' u6 AAE'(i.L-E }7F!% I L�/I�M n./rl C'N / AgME86C14eRvxoNE I l <br /> 11 <br /> 4!6 7/e-d77L <br /> r MBACTOR 1 :j ��-lY.Y' `i-1/�ff i�7 AooMeAQ of. i iczx4-duct IHaNM <br /> BDB C.HINACTO. ADOIFee wM RDRE F <br /> M OFwELLTUW 0 NMW wELL ❑REnACCmAT wEu MONnORNI!wfu• ❑OT.n <br /> /T 0 xtTAwlrox C3BYBTEM PEFAN ❑cRO68{ONNEtr REF/JB ❑VAnExT.T.. E <br /> flo 13—)oR RA NI.� roOEFTH NIMF BEr�Fr. nnBT wATM tEVEt O/ <br /> nTF of 1vLln <br /> ❑ovlaF.6EnvKEWFu 1, uM-❑DfOFHvcL • ❑ BOBeoNM �- <br /> 1rTA.— Tm. ...MT.m[FFRC Fl0A� AVi� <br /> �I..I.Al ❑ORIF BOTOM OF WELL E%CAVATNN OIA OF CC.CTOR CAS. O. r <br /> WMEBMFWVATE 13..EL VAC%MRE I OF CANHpRLEELNLT qA.OF WELL CA.. O\`/ <br /> FV BVLMUMCIPAL ❑Of . DEFTN.1 ROUT AM RRECIFICATION S <br /> owp%TIOH/ ❑O ..HTTHER ..HT BELL NISTA.BY OMVT BRAID NAW <br /> I. <br /> F Jf <br /> J AIOMOAA. aW1R SEA wMNo:OY- Ow poRCNTE vmEeTAL avomen:O v.. ON. <br /> CMN%.DRRTN I...CM.RR e0%/ROVE AFF <br /> OID[MO CONfTNCTONMMHLFRB METRIC: MID MTAM AIR ROTARY AIDER CAKE OTHFF <br /> `f VERIAREO Y CERTIFY THAT I HAW R THIt AAl1CATNN ANO THAT THE MWLWLL M COM N ACCORDANCE WRJO <br /> H BAN ACRW COVHTY OACMAHCEB.RTATE IAWB.AND RUT[ANO <br /> NOIAATIDNB OF TN BAN MAWIN COVNTY. IDME OWNER OR MIOAMO AOEM'B BIONATUM CEIRIFlEB TM FOLLOWNO:'I CEMFY THAT W THE RWONAANLE OF TIM MM FOR WHICH <br /> Mt IERMrtN18NE01MALL NOT EMROY R11WNe M{CT TO WOPWAN't COMIp[ATpN AWBOFCABOIMA'COMMCTOn'BHINNOORSMe OMMCTINOBWNATIIFECmM . <br /> 'HE FOLLDVAIN: '1 CNRiY TIUT W lIN MMOBBIANLE OF iM WOIN FOB WMCN TUe PfN.IIT le IeWED.1 MALL EMAOY IFRWNt BIINIFLT TO WOIIVAAN'B EOMFNNtATIOM IAWB OF�"' <br /> AiDNM tHE AMECANT CALL[I 10 N AWAM 7 ALL NNIIR®gBIFTNN AT RMI.tlL%6.COMAFTE ORAWINO AT LOWER ANA HRO D . <br /> �...% (IIL'lL' i a'.;v^INH d/,U'�rZ,4 / .. 1-9!-1 ��) <br /> ROt THE PROPERTY. <br /> BeNI bNs� - <br /> AMEBOFITF OR NJID[NEARe I1DOneA.. TRNOIFIRY. t.LOCATbN OF 1DUBF CROCRIAL BY6IFMORAWABED <br /> .1 LAM.HRR OFD O TIOIF*AH OLOCA ION OF ALL ANO NORM RRO1 IM E%IANBNN OF BEWAOE ge.8 .ITFMB. <br /> BNNI.. OM .C. LOCATION. Al E%I AT ANO pnp .Y., CATNN OFRT LLA ADJOI FR OF ONF HUNOIIED i1FTV Fi. <br /> 6iIlIKTVNB.WCIUMHO COVFIOOA el'ATDA,ONJAVAYB,A.WAIAB. I. <br /> THE PROFERIY Ofl AOMIMBD I1gNfiT1'. <br /> �H <br /> 6. <br /> FEB 2 2 Tggq <br /> IIMRr�une4irH s[n�ioLF.s - <br /> 2NVIR(FNAgcENigl_gE41TF DRK4Km <br /> .1 1., O ARITMp1T VAE ONLY <br /> 1 <br /> u DA. M.Y D.,.laz9 4 <br /> h,. ilio zq.gq . Tnl etc 5 o w <br /> MOA I FACM <br /> 11 COOED I.HHO AMI..1ITEO CiRoomA.. nECBVEO BY DATf RAAAAH.OiNCE...TNI,MBB1 INVOIC[ <br />