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V"v 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)468-3420 <br /> NOR-REFUNDARLE PERMIT EXPIRES 1 YEAR FROM RATE ISSUER <br /> R:eBIPYM In TlbhntBl - <br /> AWUCATpNISMRWMADE TOTEST BANMAWMCOUNTYFOR AKRAFT TO CONSTRUCT ANOMM INSTALL THE WORT DEBCWMV.7188 AMT CATION 18 MADE IN COMMiANCE WRIT SAN <br /> r MAOVN COUNTY C FMEM TITLE CHKEER <br /> .ae A,�opylrt,�BB„on Am/ R-�G1115.37 <br /> �GW <br /> 115.97 ;'�RM171`BAN MAOVIN COUNTY PUBLIC EAl1N BfRNCEe:ENNPONMEMAL HEALTH OMeION. <br /> cm 'q.*A/X✓ rA�EL Nzvux/ �jA <br /> oWrRlti xAEEELVNIL� yfY�QF_'� REDEEM. pp rNoxEr .'%9g',9/6f'i� <br /> coRRAeroR FI2G`7'�/J5 [r�Evfi .�Nrr/ ADOMe./�7gsz �G ®N�� Ixr `76- oxONE r,�I.S'.r2$F I/ <br /> MIe cO.rRACTDn ADMNtl ucI moxe <br /> Evfe of wELt/wMM ❑New WEEE <br /> 1J.... ❑MOMTORIM tMELE I ❑DTNFR <br /> ❑MBTAALLLMN O wELE SYSTEM FEVAM ❑CREM..FNECCJT..MPAM E3..EARACTa , J <br /> ,nn ,-1 ❑M— — N.R�� OERN PIMP BETLELFT. EIRSTWATERIFVEL VOuO <br /> NFREN'PELMET / <br /> ❑OVtdFtMCE WELL ❑OEOMYBKALWELLI 13 .0n.eONIa B <br /> 0 wSTRACEIOM <br /> r INIENDEO MBE T I W CONT RUCTION.1.1...MEN. A <br /> ❑MMIBTRAL ❑OPEN"PONT MA.OF WELL EXCAVATION VA.OF CONDUCTOR CABINS O <br /> ).00ME%TKSWVAE ❑OMVEI.VACS/BRE TYPE OF CAMNORTEELAVC MA.OF NT:LL CA. O <br /> 0..... ❑ORVEN DEFT.OF EN..E BI4CNSATMN R <br /> ❑SWOAIaaAO ❑OTHER OnOM.FAL INRALLFO eY OroM SMNO NAME E <br /> r_ ❑MoMr.... anOM BELL R/A114D:❑Y- DNR cENRcMEEIEDESIAE%YDNLLER❑Y- ON. s <br /> APTOL BORN /36 LDORMOI:NESTER.,DsEDVE FN4 B <br /> PROMMUL CONB111UCROXIMTWMO MYETMN:MIA IIOTAR/ AIR AATAM AW ER CAME OTHER <br /> I M4BV CERiY THAT I HAVE FREMEO TMB M AMM ANO THAT THEW WWILL eE SONE MB CMANCE WIPE Bal AAWM COUNTY OOWARE.O.STATE LAW.,AND RULES AND <br /> MOUTATMNB OF TIF BM AAWM COUNTY.MIME DWMII OR e1CFNBED AOEM'S SWNATNM CERERRF Po <br /> S THLLWSb <br /> O :'I CERTIFY THAT M THE IEYER NOMAAHCE OF TW FOR WIBCN <br /> iMBMANT IB ISSUED.I SHALL ME EM0.0Y PERSONS SUBJECT TO W011RMAX'S COMPENSATION) Vft OF CAFOMA'CONTRACTOR'.NIRNO OR WB ONIMCTMO B10NATUM CERREB <br /> TM FOLLO'MMO: '1 CERFY TNAT M TR PEM 1SAalCF OF TM WOIR TOP WXKN EXIB MaAR IB MBVED.1 WALL EMM1OY RREDHS NING A T O WMMMAM'E IRAN.. AEMM UWS OF <br /> CAUFORMA' TXE AM iM[,T CALL]A C�M YwANCF 1011 ALL MO1MO)/�M/FERC1aNB AT <br /> INNI BtliLEE.COM0.ETE dU'MNO AT LOWEII AMA MtlNDEO. 4(� <br /> TM. <br /> '® ISE FUN 8h-1.B IN <br /> AME.OF.IME,.OR.M.HEARST TO OR SOIIIIdNO ENE ROP"N'. t LOCATION OF HOUM BEWAOF gBPoSa SY.TEM OR PROPOSED <br /> i. 0buUNE OF THE FMMRTY,OIMa DMENMONS ANO NORTH MMCTON. [APMWONOF MA.1 DLNOBa SYSTEMS. <br /> T. EHAD..MO OLEEMM.A'O L.AT..OF.EXIRMO AW NOIOMO t.IDCATON OF WELLS WTi1eN NDIV.OF PER NVNDR.FIFA 1. <br /> STn ICTVR..MCWMNOCOVETED AMA.MUCH AS PATO%.ORVfWAY8.ANO WAIRS. ^ ' OM THE PROMREYOR ADAINRIO IMO RR . <br /> SIR <br /> 1f1A <br /> Ann <br /> PAYWEN P Tl� <br /> RISE APR 26 09 <br /> 9c NiY <br /> 1v v' H fAVASIpN <br /> Ann <br /> NPINNIw..V•yl.e., � <br /> M.M I.ePr1Mn BE DnF PmPlmp�+Um eYZ ��/ I /////I//-.fit. --.ONE <br /> OSIneBm I�o�a.n.V 0.N <br /> C„..... PLATE 11, Page 11 of 16— <br /> COUNMNO OMY: AT/ FA<I <br /> YS PE COO[. FEEMEO AMOUNT..IT. CINi FMN RC..T 1 DATE j '.D.OINCEREOVF...HIM.AS INVOICE <br /> 0110 50,04 r} 0N64 <br /> aa� <br /> Pub Henn SeM.-EEMTD.179(1197) <br />