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0 o�ozz <br /> APPLICATION FOR WEWPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,904 EAST WEBER AVENUE,STOCKTCN,CA 95201-388 <br /> (2091469-3420 <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM RATE IRBUEB <br /> ICoEPAM In Td RFNANI <br /> APRKATKCN IB HERE BY MAGE TO THESE SAN AAOIIOI COUNTY FON A REMIT TO C0MTPVCT AFOALR IN6ALL THE N WOECCNBEO.THIS APPLICATION Ir MATE IN COMgMNCE PATH ME <br /> JOAMN COUNTY OEVFLORAFM TRIS, <br /> /�CCHA ENE&111115.3 N0 TM STANDARDS OF SM NAWW COLETT�/YYPW WAtTTH EERACES.ENNWM.IFMAL HEALTH OMFION. T <br /> JONAT.N.L.OIA./ M! 1 TL/OI AIL &I CTY('�J}Y/4�FyfL�I' FNICEL eOF/HN/ �/�</TEJyrT <br /> O 1A.NAME ,/ !,. I AOd1ESB .JC LFI 'IC/I' �C/'LI �q�y).�RIONEI�YL Id✓� <br /> CONTRACTORy e !•W Ao ..T=Aqx ,V'sioll.. dPHONE. <br /> PAT COHT.T. ADOWrr ucr rNME/ <br /> TYPE OF WEWRIMP. ❑HIM. ❑N91AClLYM VELL ❑MOMTOM MELL/ ❑OTHER <br /> ❑INETALLATWH ❑.S,ETFM PLPAM ❑CNNNcOMMCT WRAM ❑VAJOREATMCrENIWfILr J <br /> ❑N..❑N.Fw E. OEM RMP rtr_Fr. RWTWATMLEVEL 0 <br /> TYPE OF MSIM <br /> LF 0.r-.WELL ❑OLOINY6ICAL WELLE�V' ❑ BO0.WNM0 N <br /> A-SIINICTON: l vial lav Q� en df? nku) A 11 wfN fienfy �,1. [3/.' s <br /> M,GOFO 0e[ ER OF EL A <br /> ❑ARM REAL ❑OPEN EC'.. EIA.OF WEU ENCAVA K M.OF CONDUCTOR CAMM D <br /> y ❑COMECRCM1WVATE ❑NAA E PACNMOE TYPE OF CASNIO/NTEFI/PVC OAA OF MELL t.. O <br /> ❑MICMVMCIPAt ❑OWVEN DEPTH OF ORWT SEN SPECIFICATION A <br /> ❑MNOATENH. ❑OTHER OMVT FEAL NIRMIEO NY NIOUT e0.410NMTF E <br /> ❑MONTONNO ..OT REAL PL.13Y. ❑x. CONCNETEIEENEEEA,.TENNEENI 0. s <br /> AFF 1 OVEM LOCNMO CHESTER mRBTOYE RIE C <br /> RFNFm CONrT11VCTON.LIFWNO MAMO:MVO ROOMY AM NOTARY ALDER Cu OTHER <br /> I IRYB/CERTRY THAT 1 MAN PREPAiO THAT AFWAX ON AND THAT THE WORC NTLL M COM W ACCORI WITH FAN NA SAH COVNEV OmINANCFe.STATE IAYX.ANO FERS. E <br /> RTIMTNMY OF M FM!AA MN COUNTY.HOME OVMRI OR LICENSED AOEM'S WO..M CENTERS THE FOLLOW W:'1 CHOI THAT W THE PERFON.IA ECE OF TN!NOW PER NM0.l <br /> TNI.KIOAR MEeUm.l MNL NOT FMRMPPRWNe WIJFCi TO WCRMMAN'F COMFBIMI WN UWS d CHEFORNIA'COMMCTONBNRYNOOR mNCON1AKTW0 MONATVRE CFIFIEEI <br /> TM PTLLOWVM: '1 CFRTEY TRT M..EARCIMAEd .MORLmR W1N[M TMF PEPLtlE M ITMIFIR I MALL ENRAY If11SONS WSJ[GT 10 WONWMI'e COMPdM1gN IAWe OI <br /> CALNOIFIIAaaa....'���Errrxyyyyyy//////.+NI���rrwEE[Ilrrr���eee��/NE M�UTTT/CALL]A MOW M ACVMC!iN1 ALL II[OtOlm INFFKMM AT IENI.NJPL.COMRR!OMWMO AT IOVNR AIEA�„� �j <br /> WEYN U'/AA�'F'l /�CiYFYE*A <br /> T. �i ON. � 17 C <br /> / ROT PLAN 0'—M"'A'..AI._•M <br /> ,.NAMES OF PTTs ..11OAOF ENAMOT TOOP LOU4. 10 THE Rarmrv. a LacA*wx C,NEW.rEWAaF aweu mETM OA PnoroFEo <br /> E.OVTLNM OF THE <br /> RIOIFREV.OMIqNgNB ANO OENSHI OPECTON. L(PMIepN OF IEWAOE CISPoSN eYREMS. <br /> ].OIMENSgIRO OITLMIF ANO LOCATION OF ALL EXISTING AND PROPOSEDS.LOCATOR <br /> WELLS ELLS V+,THIN MWOr OF ONE HUNDRED FIFTY FT. <br /> STRUCTURES,RCLLMHO COVETED AWA.MCH AS PATIO..MIVF S.AND WALR9, ON TNS SMAI NTY OR ADJOININO TMFf1RY. <br /> y7 PAYNir-tyj <br /> I ,jb 666 ® NOV 41997 <br /> 'S f I-tlVIR!)N WAL HEALTHI NO pN <br /> E'le <br /> MPAN,MENT N.FG.L. <br /> APPI..II..ANAR.F h D..-A&[a _ <br /> D..H II.F.R.I.Fr U m R.M NNF.r.,h On. <br /> D.-I.S.ILP<IL,h � D"• <br /> �. <br /> HE Co. Prt NTT AAAFFLINT RwTTmc v AFH A[cwm rr own ,+YNmalxl N[OIEOT xuww <br /> o v6a �L v 9 0! i Oy�3 <br />