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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES O O <br /> ENVIRONMENTAL HEALTH DIVISION Jrs /—qY <br /> P 0 BOX 388, 448 N.SAN JOAQUIN ST. STOCKTON,CA 93201-388 <br /> (209) 488.3420 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 1 <br /> IC.EFYN Y TFpliBW <br /> N ATgN IS HERE BY NUDETO THE BM`JOAOU W COUNTY FOA A KFART 10 CONSTRUCT ANDMA INSTALL THE W0R(DfSCpBED.THIS M ATpN 16 MADE N COMPUANCE WITH BMI <br /> JOAOUIN COUHYY DEVELOR/A W TTI(R�E.CHAP/IF�118-I I I St.3 MD THHE BfMDA OF AN JOAd11N COUNEry RINK NFNTH BFRNCES,FNVIMNNpRAL HEALTH DINBMJl1. <br /> JOB ADDRES"OR A//4l�-6 ]OL �[t/IGfI/I /`!Y p[ cR, IECFM/P(�) PMCEL 142- <br /> 5_'10 <br /> �4.k ADDRESS 6 .r4 FYsA11' RIDWe.. Z37-9 <br /> OwNEAT:NAFE ./•. e pY'ry <br /> CONTRACTOR Mo1 or AvE nN 5../�11W ah- S„<h."L S AmREm Z/7011.�/,y1�.�� ucB YL yQiL�FMNE' r/3)-3,2)O <br /> 6UBCONTRACTOq I�<L5'C j(1$ AlYI )'I,PIO ApOHEs6 ))y ALBe s -4k&bz Z.- Z2- <br /> PHOTEFS )tiZS <br /> T DFWELL uw: HEW WELL ❑ ME EMENT WELL ❑ WNO,omw wra I, ❑OTHM <br /> ❑NBTAaAm. O M"S, <br /> S,Y FmREPAIRO cROBsceNNEcr Tr.Pun ❑vuoR ucTRUcTwN wEm E J <br /> s L,Lb �Nw C]Rg4, H.P.yoyb FIRST w.T.IFVA 0 <br /> TYPE OF MUM <br /> ❑OOTUE-IMMENEU 0 DEEN,R ICALN9IE ❑ BOLL MIME, B <br /> ❑DESrwCT11M <br /> INTESO-0 YPF OF WHI 5,'gNBT11UCTM)M iFFCIflCATNiNB <br /> (J 4 <br /> 01NWSTRALI❑q OnW BOTTON OUR OF wEA EXCAVATION gA.OF CONOUC10q CABIN. 0 <br /> ❑wNE8i1cpI11VATE Ra GRAVEL PACKIBDE� TYPE OF CAaxc,aTSI QUG waAOFv,Eu CA81N0 fi"s JC. O <br /> FURI <br /> q❑ CMc ❑DAVE. CEPHI OF GROUT MAL SUI SPECIFICATION e FL7 A <br /> Ja NNGATNINIAO ❑OTHER GROUT SEA,INSTALLED BY eivow BMHDE <br /> ❑Mawromw SHE.SEAL RAMPED:to v. ON. cGNc1ErE RTESlALnoFEEEw❑Y. ®N. s <br /> ARR.X.DEATH -900, LOMW EMIRM SOXrcfOW FIE_ a � <br /> FROMM COTNTRMIRDI SMUNO AMINE : MID ROTAFY_Z— A"ETMY AVOEq CA —&F OTTER <br /> I HE4SY CER1FY THAT I HAVE PREPARED THIS ARYN:ATN)N AND THAT THE MW WILL BE GONE IN ACCORDAME wRN SAN JOAQUIN COUNTY OTONIMKf6.STATE NWS.AND MU.FHD-Cl <br /> nEOULATpNB Oi THE BN!JOAOUIM COUMry HONE OWNER d UCENSED AOENT'S..NATURE CENTRI THE POUQUA G:I CEIOVYTHAT N THE RRFOINNICE OF THE ROPE FOO W WCH <br /> THIS RbAR ISNpUm,ISHALL NOT EMPLOYFEIISON66USJECTTD WOIIKYANY COMIdFa .LAWS OFCNJPoNMA•CONTMCTORSIRIEp 011WBCONRUCTNO SpNATUR CERTFEE6v <br /> THE FOIESTN N.: CFNTIFY TIUT N THE RAF.WAAHCE OF THE VAIY(F'lfl LNYCN THIS RRMNT IB IBRUm,T fiHALL ENRLY 1ERBONn BVNfCt TO WONGIAM'S C.YPDYRTNw IANT of <br /> CA:RNW- TI A~uwRT MUST CILLL N MUNI;w AOVMICE FOR ALL REOIMED RY AT N'MI 6Mi44 1 CONRETE OMiAMO AT LOW91 AREA RONOEO_ <br /> IN RS., DRR /z z 5<_ <br /> "T FLAN m,—,n!MY,sN. •I./ <br /> I. NAMES OFR ROAM NENmov TO OR BOUMANO THE PROPERTY. A. LOCATNRI OF HOUSE UWMIM <br /> E DOSAL SHOREN OR FINIIOSEO / <br /> ]. OUTUNE OF THE PROPERTY,GRAND IMENI <br /> ND DNSN6 AND NORTH gRECTgN. EXPA .OFe ARE pepSAL SYROM. D` <br /> J. pMENNONED OURINES AND LOCATION OF ALL EXISTING AND RppSm E. LOCATON Of WEUS WITHIN M S OF ONE HUNDRED FVTY R. <br /> STRUCTURES.INCLUDING COVERED MEAS BVCN AS PATIO.,pDYFWAYD.ANO WµX9. ON THE PROPERTY OR ADJOFIN.FIOPFRTY. T <br /> p- <br /> Wc0 <br /> h� 23� WA <br /> moo <br /> R'° ,I . r <br /> yE <br /> Rry .. <br /> !.. . .. �Ns w 1Je1l. . I <br /> i <br /> , <br /> i <br /> PAYM � . <br /> p. s Iwe .. . . ' <br /> — F*id IRI )I II <br /> DFPMTMENT I SNI - _ ,•;.IOIN <br /> APF...E,.AwmIN Br_ rF�/ DN. ANA <br /> BY ST <br /> cH�.m.Hr <br /> Acc.UN:Tne 0-T: Nw FACT <br /> TE E.m fEE 1EF0 AMODNTIO um cNE MH R WUFSDBY DATE PERYRNTRNCE 162M NI"An wvDICE <br /> *a is 3 -5" 1l owl l3 _ <br /> 0 O o SRo 034/3 <br />