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APPI.ICATION FOR PEIWIT <br /> SAN JOAQUIN COUNTY PUBT.IC REALT'4 SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P O BOE 2009, STOCKTON. CA 95201 <br /> (209) 488-3447 <1y79rN <br /> r' <br /> PBREEIT BEPI(iB3 1 YEAR PROP DATB ISSUIs9 <br /> (Complete in Triplicate) ...I ,,, , <br /> ApPLIM"e11 11 NAnbT AAAA W $A J ule Count for • ' 1991 <br /> DAR 7 ty Crt to cenNo.V tt And/er 62 till the vork Mn1n oe¢r1oM. TT3A <br /> .01016 C ty RAGA lA to;h 1110" t�Ith". 8�e Je�yulo Count' Ora Lunel No. 519 Ird 1862 uN tM R,.y. {�qrW 8An <br /> �eyr1A Cavy luyllA Bnit11 Mnlen. ery��AL 11tHL7Fl <br /> Joy AAOrAAA <br /> 44SQ-4 /1b .TifGK 2DNe- Aa C"— 1'5r t Lot 8Eu/AcPE�RISEP/ICES <br /> t <br /> 00w.NyRly-211AC A /btGS 6kA�ft6 A9dA11 IWA TD"JF AD phoee - <br /> '' CTahAtT Hress 2BL5' E. /YIYRTLI� :f�ni L,cense No.sz2268 monk - <br /> TYPS OF WELL/PUM►. NEW WELL 0 WELL REPLACEMENT n DESTRUCTION 0 �!—• <br /> PUMP INSTALLATION 0 SYSTEM REPAIR G OTHER 'SRA AA �_,•'-YT <br /> DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. "A"- Y*6 <br /> 3l FOUNDATION AGRICULTURE WELL _ OTHER WELL -�u✓:+'dMM��CpCJ - <br /> + INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPEC."CATIONS NOII}I7T• <br /> ❑At0u11TtM ❑Dan Bo O MArItocA Da. of WIN E.CwAtgn amu.-wvraFgMq E r <br /> U W/MFKe/hMM 0 GPM►FtY ❑Trµry TrpI,of C <br /> .. - M Ps 11 Onw. O 00's OAp,n a G w <br /> hiSwl SrPF-efe NV 644' <br /> .. .'C MgweR ,Appro.. DTII .J Enlan SI,6"SAw InMAAAe et' F <br /> RlaAir WMy Dos U Trey of Pw V H P. SwrrWvrE-OtRw_ •XFFL(- �!� r'I <br /> V401 DAw ye"A O Wed ow ow 8w11% R.MrIAl A Depth !f <br /> Depth 1_119r Its nt&1 A Depth <br /> 770"TWIFFMINCIAK, NEW WSTAIIATN)N REPAIRIADDITION C1 DESTRUCTION 0 INo W,c FlMern W I,,N,t:4 p,. kAww• <br /> Avw1ADIA w "2001w.1 - <br /> BMwBM EIS Prow Raoft q— Comt 01— Dow <br /> 0MAroAr of"MIRE:_ Nw 60 of bAwoontA <br /> .p <br /> C21I11Ae1w M 00 M A thpAl M 1/Aw: WAM talo AAptn --� <br /> 2' {[►TIC TANK O Tww"we CAt " No. CorrlpArTrrrrlN Li <br /> ' -PRO.TMAYMMY PET.❑ MnMe of Dw"W G <br /> I, <br /> t s• - OIAtArICA ro rIAArAAI: WON FowNwion hopArTT lirw <br /> it.(ACNwO LAW O W.a LO-40 M yw Tola Wvh/ws <br /> '..wrtm BED ❑ DiNrtcii ro tIpfg, I: WON Feur10Aten hop"Line <br /> BEEMDE PITS 1 1 D404% Sin Nurnbw <br /> SUMPS LI DierreA w Iwlwe: WIN F&Aftftwi Propwty LSM <br /> -..DISP I PONDS O <br /> I MIAOy AA WV TMt I hM prA0ArA0 TAE OPPk W Arlo Ina TINA work wA be Ourw M ACCwewKA w+tn SM JoEouin cW wp'MTKn,ttstA' w wte <br /> nAEy w Itplpt Of the Stn Jost on Cagy <br /> � .� Up11IA 11 I w b0snEAa AaArR•0 E"tW110*eIlf"tNA f010"-"I CA Ify tMt In ty MHOrrMnCA of IM v.wk Iw.Mich TIA W",t"uAE.I"rot$No6 <br /> w "NNAPIA w1,0wI M 111,;hRI/trfAr w ro blcwnA ft bwt w werkrrlM'k COrrpAMAtOn Iwu1 of C.Mwrw."Co IrKtoY1 h+M9 a wMCHttrActap 0I- 1 SIM Ywt w CAfrerRY.-owwv rm M owpArTeentArtct 9f tf,,wwk fa Mch tho PwrrYt a•I.rAA.I"wto"PII wbllct To ,wle-A CM1pMn �. <br /> TNA APMIAM tr�I w he ConWaA bawq an mwr kM. <br /> . <br /> SWAN R-S.jL]VYd�1i-iL Tie.: eNe, e4o�isr _ wT.: <br /> _ ��� FOR DEPARTMENT USE ONLY <br /> AppStyoonOKp <br /> ANA by • ^'MNC� `se pal OMA v r�r/� Arw <br /> A w OroIR IrIlpAchow M DAa F+IM <br /> _ f � Ioton s <br /> AdNN1, CNs. H/,,, i 7K J �'>•_uin DAro b 7 <br /> AWUCL11t - RI all o"I" Wt yAR JOkQOIR COL,,. Ph111IC HILaTa 801VICRP <br /> otyt AofnTptTAI RAALTR DIVIRION PIANIT/BEAVICILS <br /> AAA R SAR JWIQUIR. r 0 1101 2W9, ffTQCKT%*f. CA 08201 <br /> µEAtwpDNt DUE ANpt4rT nt u,rrt0 c. n <br /> 11 Ar UAtt gewt NO <br /> wr0 <br /> 0'.9 �j ^ <br /> IM �AI <br /> I <br />