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ODbD3 / <br /> APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 988.904 EAST WEBER AVENUE,STOCKTON.CA 9,201588 ! . <br /> (209)4853420 <br /> MON REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> IDOIRPIRW M TIIPBcal.) <br /> AAR=ATION 10 HOE[Y MADE TO THE US AAOOIN CWMY AOR A HEARST TO CONBfMICT ANOgN INSTALL THE WOW.OPWRADEO.THIS/.RUCATxIN M MRO[IN COMWANC[WIFN MI <br /> AAWIN COOMYOEVELORRHI TITIZ CHARTER 11-1115.9 ANO THE STANDARDS OF SM'MAW.COUNIV MERM HEALTH REAMER.EHNROWIEMK HULTIP <br /> .AEOEEBF]^R]A]�RS\A'LkInCN ERV CT' LO�� �� PAIICR MSPIMIII\ <br /> OWNER•.xAME \`t'�Q[� deaJli�oAoo ARdIF.a a�n� .x..��. Lty]'RA.a PEASE I, w 2.S'�a <br /> cOHTL OF blN\VC-- 9, V`lwx "J1 AooWR[ ����c N.�`VP9V1T�Lrcr FExrx[F <br /> T <br /> Bw<OMMCTOn AOCRFS6 IICI .IOM/ <br /> TYPE OF weuww: O.W ❑I FPFEHT wWL ❑MORRowM wEu• ❑eTEA <br /> ❑WSTALLATAH ❑WEu SYeTm REPAIR ❑...A,..Re" <br /> 'yK�PAIR 0vA1011 FATMc[AN�wAeu• A <br /> X.—o. .P OFPTX WMP aEETp,.iFT. ASSET WATER LMRTQE O <br /> R ROfAMR <br /> ❑OVTUFttnVICE WEII 0O[oRIYe1CAL WELLY ❑ ,00.SOIEW I <br /> ❑gAT.-r <br /> YF{ Yf[OF WELL COMEi11OC1bN ERCIFICTwx A <br /> ❑....A, ❑ORM SOTTO. WA.OFWALE%CAV NqA OF=D TOA CAARNO O <br /> ❑WMERTICMYVATE ❑OMYEL PAC%mIIE ryROFCABINOFSHFHP 2 ENA.OFN CASWO O <br /> ❑PI.I..NKIPAL ❑OWVEM 0[RH OFOMVT TO. N4CIfM:ATMN S <br /> WMOATgN/M ❑OTHER SPIRIT SEAL INBTAIEFII.Y OMUTWSANONAME E <br /> MoxxowM OMWaEPAMPAPE.ll Y- ❑x. CONC PFEAETAL[Yq 11. ❑N. a_ <br /> AUMXI OERH \S U 1 LDC%SNI GREATER SOAIROw R d. <br /> TOM..COMR11UC1DMRMWXO MFTMO: MIA MTARV AIR ROTARY AUOER C/JIE OTHEA <br /> I HEAHFY CERTFY THAT 1 NAVE REFA IM THIS AMICATNIN Allo THAT THE MW NAL BE DOW M ACCOECANCE YTN BW MAOOW COUNTY OIdH.S..STATE NN9.ANO RgEF ANC <br /> ROULATWNSOFTWRANMAOWNCOUNTY. MMEONNFEIORIlC MAMW'SMONATUWCERMIEETWMLLWNN '9C[IRNYTMATMTWRMOIMMCEWTWMWMRWIIICE <br /> 1NIR RRNR N IBSw0.1 RMM1 MT[MROYRASONS WSJ[CITO WONEMW'R COYfpRATOM UWA W CAIRgNA.E.'CONTMCTMY NMW MI SUSCOWR TMO BpNATUR CgTIFNt <br /> THE FOLLOW' THE <br /> '1<E1RIA'THAT W TN W VgAMES ROP TII[WPER A O YMICX T HE RMOT IB TSUEOR EP y[.ROY RRSOHF PANG AT TO WORVAAM'R ADItI, STpN 1AWF q <br /> CAlIFO1M1.' TM��IT��IC``IINT M��WT��CALL tF M W M SOVYC�[\IO11 ALL SFWIRm INEfFCMMF AT 13N1 MYE[.COMPLETE OR.LLNM AT IOYAII AREA FRDVgIfO. �} <br /> Thl. ��O�l—�L R9��A_>_. F.,. L\ `\lo <br /> ROT Aux Imaw I.awl aRH._ <br /> I.HALER OF FTHEETA on w]AD.NEAA 1.TO OR BOSH..THE RMRAY. x SEWAM.aMa.arm.on rMTMo <br /> oNLMf OF THE IMRl11Y,...A IOAI OF O NAHMRN g PROMISED <br /> A[%P.l..RMIR 1 .. .MORAL .O FPAP. <br /> ], TPUNT WOOVT.NFA HAVERED AREOf.L EARMONAE AY.. F.LN THE PR OF WELLS SEAMSMONKWONE MUNONOfITTY iT. <br /> BTNKTUIEB,IMCLUOIMLOVERO AREAS NCNMPATpt.OIEYtWAY R,AHO\W�AIAe, `` ON THE PROSPERITY OR ADMINgO RpRATY. <br /> V Q.Z A <br /> PAYMENT <br /> RECEIVED <br /> APR 0 8 1?Rr, <br /> SAN NTY <br /> G PUBLIC I-EAo-rr VICES <br /> 9 ENVIRONMENFA.F ».. HOOIoION- <br /> V) t Aa <br /> N <br /> N IDLE ROAa <br /> 0 <br /> a <br /> J FTMTMmn we axLY �.IUB p 1('(}, <br /> APNk.Rw.A...Fx/M� , 'E� <br /> a.M N.AP•NEn M FLRm Irp-A.n SI.� (JY//d//.G . LLL S <br /> os,...lx.FwSw F THIS <br /> welt l d,,I d 44�Yal Pcl.it <br /> xa onr: FAC. <br /> Pe coon .Hao .7F. AAsx Tcxv[O er DATE TmTVECF"PROPER <br /> { wx1A,Rw .vox:[ <br /> sp L Sa is/a daga3/ <br />