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APPLICATION FOR WELLJPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �\ 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 <br /> NOR-NETURBABLE PERMH EEPIRE9 1 YFAN FROM BATE ISSUED <br /> (CMmpkla In TrbBnitl <br /> ITER BY MADE 10 THE SAN ASAWN COUNTY FOR A FWR Ar0 CONRrnVCr AWRE AMATT VA <br /> THE NEOEMEMEO.THIS ANVCATION IB MADE N COMNEANCE WRIT SAN <br /> JOAWIN COUNTY IN.DDISMENT TOTONS.CNA/rtqIll <br /> 11113.3 AND THE/NANDMOeOFRAN JOAOUN COUNTY El BEIIWCM.EMNROHMEMALXGITN dNSgX. �J� <br /> I..A.Sl nM\_�M S`Dlll A'1..'L 2O�i1 GL Cn.'rJ� �IM P EL pIZNANII ��/Z�,Op/)`E NS <br /> OW ..AA 1�p <br /> � cONTMMTOn E!'V�q t'o.[fll' p,H l_�ilf' ee[� .(�/.2CvY /L✓iP�7 PTm.E�>JYr .'f� <br /> eW CONTRACTOR ApdEM uc* END.,I <br /> TYPE OF WEI1pVMP: ❑MFW WELL CFATMT El ❑MOMIONHO WELL a� ❑OMMH <br /> ❑NpfALL . ❑wBLSYNEMPAP.W ❑CACHE..XNmTP£PAN ❑VIAR O[iMCTpN WVLI J <br /> ❑Nw❑MWX.P .1.RUMP eET_R. HRBf WATEN I3VEt O <br /> Or OF RIMR <br /> 13OVf-0FeERVFf YhLL ❑SEG Y E LLI ❑ ml BOWMO p <br /> Da---CI-- old kvit A C i/p� Th a l-c+`.la{t.���o C'.� in lE'c; &-6(e n <br /> —o <br /> INT <br /> I"OF END, c.xaMMnax aPEcmcawxM __ a <br /> ❑PN rermAL NpOFACE dA O[wExL EACAVEEwVC CIA.OF caxOYCron cABRm O <br /> W .w.vATE WULCAwD ��-- <br /> ❑WBIICrANMICIPM ❑ONHN PMN .ETN OF OTtlVf REAL tKCRODAE.. R <br /> ❑IWVOATpow" O.M. OROVf 6FAL NerALH1 BY OWVfpRANO NAME E <br /> ❑.Rm HE...D .RDvr.F.M weAEDF.9`r ❑n. C.C.TERl ❑rr s <br /> LOCNN.c1ENEN eOX/rtOVE N14 <br /> R,OPo3m CC.MNHUSTONANWNO MEW.:MVO IET___X1_Al.ROTARN AMEN CAME OTNEq <br /> TNMIEY C FATTY THAT I NAVE PREPARED TNM ATICANOM AND MAT THE WOM WAL ME CONE N ACCOImANCE WITN BAN AADIN COUNTY DM1 E9.NATE LAWS.AND All AM <br /> •OF THE SAM MAd11N COUNTY.NOME D AMON OR MINORCO AGENT'S M ONATUR DISMISS WLL CEMRS FAIDDS'I CENNH YTHAT IN ME I4IEONAMFE OF THE WONT FOR WIMN <br /> NNPERM.MMSVEO.1MM MOTEMMOYMMSONMmR TTOWORDMN'SCOMFFNSAMNLAWSOFCAIEWNIA'CONRACTOR'SXINHOORSVB OMMCTNOMGNANIECEMMFS <br /> THE FOLLDWINO: 'I CEINIR'TW.r N THE PEmOMA E OF TW WOM FOM WNICX THIS RMRR 1.Ip9Um.1 MALL MROY RMMNS.UNECT TO WOR M-S COMR .AOG.V .OF <br /> C ALFOWPA' ME IUPPIEO,,NxAIA�r MYST CALLy 3A/M LW IM ADVANC E FOR AM INSURERS InN6TDNS AT IAN AtlJT3L COMRETE ONAWINO AT LOWER AEA FOl <br /> elE.Ez iv FPl AM I.A. <br /> ROT MN On—roMYx S.N. 1._ <br /> It <br /> ANTES OF STIENM OR nOAOM NFAPEN TO On eDVNdM INE RpNATY. OF HOVeE cEwpOE dBgpAL ryBTEM On NbIVNO <br /> .lMI EOF THE IRVRRTV..DN..H.AND <br /> NORTH dMCTpN. [SEWAGE O,SROc.EL tYNMM. <br /> ..OF ALL EANNO AND ROVOtm S LOCAHCN OF WFLLt WTTNM MdYM OF ONE XVMN.O FIRM N. <br /> YVEO AREAS INCH AS PATES,ONVEWAYS,AND WAIS, ON ME ROIERTY CA NAV ROTMEND" <br /> y <br /> 60 <br /> LL <br /> W1_OIJ. c� .. <br /> �Jr`ra��i) FFd Sz z <br /> z , <br /> s <br /> ai- <br /> AYMENT <br /> FCtIVED <br /> / SAN JOAl3UIN COUNTY <br /> T <br /> - ,PU8IJCHEALTH SERVICES <br /> ((nII OFIM3mMT SEE ONY 9 11 <br /> RSPllv.11m A.asNR h � DOE I L Mr �`� <br /> G....I L...rl Og TMP In..—. OM <br /> L <br /> GIleSM.11 'ARM FACE <br /> �/ 9- / S' Y OepatMclEw ? !I ' au1RD <br /> CoMq <br /> { "ENVERB mk� <br /> PTENFO ANOuxr RFMYnm cTO YJ mn DATE Tl...MEOVFDr nIRAd DDINCE <br /> 3 Od ooh la IS U( 4- <br /> 2 C <br /> cob <br /> Pub HeNM Serv.-EWA.173(OYY1 ., <br />