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APPLICATION FOR WELLIPUMP PERMIT <br /> 1 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 0 BOX 388,4 <br /> 46 N.SAN JOADUIN ST.,STOCKTON,CA 96201388 <br /> \ TVI <br /> (209)468 3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ohm <br /> ICeplw i Td fiabl <br /> WHERE eV MADE TO THE SAN JOAQUIN COUNTY FOR A PEWA?TO CONSTRUCT MIOMR IN9TNL THE MW DEECOREO.THIS PRLJCATW N 10 MADE IN CONSMANCF NRN SAN <br /> JOADUIP COUXT'OF/ELDPMENTTTO,LE CHAP-9-111,6`.3 ANO/THHE STANDARDS OF 9ANNJOAWIN COUNTY MOM HEALTH <br /> IB MC'E9/,{NVIPDXMENTAL HEALTH DNWON, 13 q <br /> AB — f���i(+ �A-AL'-/4 �L/�la� / CITV(j i/-`��LQft hvl N y�PARC-EL/JLEJAPNI /N'�f1 <br /> DWNE NAER OI'(j.��ti N7/Y34,( I�NS iO�TTId�J , aU RYrC /V PJHDINEF E uJ� <br /> C OP 1. {-oc 2:16 A/ AUUNUAS a �y w,n�� NI:E✓V.( /.)IDHDM F SGS_ <br /> Wec Awu9S UC/ PxoxE• <br /> TYPE 9, ❑N.ND. ❑PEAALEMEIiT wEll ❑WKSOM.NO WMLF ❑OTHER <br /> ❑F IN6f/3lATX)N ❑ REPAUR NCPFPAR ❑VPoMpH W /� J <br /> A Ly Nan�Pwfi H.P. DEPTH NMP SET—FT. RAST WATER IEVEL 0 <br /> (FYIF OF PE <br /> ❑OVTOFARNCE WELL ❑OEOFXYACK N2LL/ ❑ SON BOPoN4 6 <br /> ORR ❑O <br /> INTEND I..E TYPE OF WELL CONSTRUCTION iPmINCATMRS A <br /> ❑IHW K ❑OPEN BOTTOM DIA.OF HELL EXCAVATWN OIA OF CONOV[TOP[A9WG O <br /> 14WSHFTICM VATE El GRAVEL S E TYPE OFCA91NCOTFEIFVC .1.1 ELL CAN. <br /> ❑RIB /MVNICW.LL 13.. DEPTH OF SNOUT HAL SPECIFICATION A <br /> _ <br /> 11 HAND ION. ❑ T.P. SNOUT HN INSTALLED BY OMUi BRAND NAME E <br /> ❑MON NIND GROUT SFAL WMKO:O Y- [3. CONCP£TEFETIN=IPfDBLLEAOV- QNe T <br /> M COCAIN.CHESTER BOXJ6TOVE PRE T <br /> IPO COMLTRUCTpNryPoWNO ORE..:MUD NET. AIR ROTARY AUGER CAME OTHER <br /> �e IHERBY ENTRY THAT I WAVE PREPARED THIS ARLCAPON AND THAT THE VXfW VAM SE DONE IN ASCONDANCEVA TH BAIT MAOUIN COUNTYOPgXAH[EB,STATE I ...AND PANF9 rWU <br /> PEGULA N6 OF THE SAN MASAN COUNTY.HOW ON,NER OR LCURSED MG 'S SIGNATURE CERTIFIES THE PoLLOWTHfi:9 CERTIFY THAT IN THERRORMANCE OF THE VX*N MR VAUCH <br /> THIS <br /> TER IS ISSUES.I WALL NOT EMRAV i£RSON6 SUBJECT TO WORNMAN'i COMFENSATSN 1AWS OF CARCPNA,'CONTRACTOR'S HIPoNC OR SUSCONTPACTWG 6WNATURE CERTIFIES <br /> THE FOUL ANSI -1 CRORY THAT R THE RROPMANCE O6 THE MW MR VMIC I THIS PERNAT IS FARM.1 WALL MI PERSONS SURIECT TO WORKWAN'S COMItM6ATRN TAWS OF <br /> L /JPUM M T 'U IN ANCF FOR OIMmIXtPSC?1/R-TXt RT..IMS-%21LCOMPLETE DRAWING AT..AREA PO�VTIOm.�"J �}/{j <br /> PoMR L ' RTIU. F/ .�I X.GI MNe I 1 CJD 7A <br /> T PCA. <br /> U.—E.A.,SWa <br /> 1.HAMS F STREFT6 OR MAO6 NEMEST TO OR BOUNDING THE PPARMV. A SE SEWAGE ASMSAL SYSTEM OR PROPOSED <br /> E. OF THE P OMPTY.RNNG R.M.N.AND NORTH DIRECTION. E%PANBX)N OF SEWAGE M 6 <br /> RCHU,SYSTFM. <br /> SHED <br /> OUTLINES AND LOCATION OF AEAMHLOWELL <br /> PINES.INL SXNG AND P OD G. CATION OF S WNNIN RADIUS OF ONE HUNOIRO FIFTY FT. <br /> CLUgM COVERED AREAS SUCH A6 PATIOS.DNVEWAYS,ME WALKS. ON THE PROPERTY OR M.OIXIN3%OPFMV. <br /> C .a <br /> _ G <br /> DEC "3 0 'IT38 <br /> qr1 v , <br /> ed <br /> i ac <br /> 1 , D®ARTHENT USED NLY <br /> 10. ApNuNnANO..Y <br /> GNeN Ett �Y Otle p Ir�pc pqA 7/iy]•/ <br /> osNneNl..,.PmN..eY '�T <br /> CanIMN: <br /> NOO <br /> ACco NG ONLY: <br /> AMOUNT nvmTrm Rmevm ry <br /> O � +33tl H 30/4 RWCEam <br />