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APPLICATION FOR WELLIPUMP PERMIT L J Z ;L 1 <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 338,3001 EAST WEBER AVENUE,STOOKTON,CA v1 20E3R3 <br /> 1209)468-3420 <br /> NOR REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> IC.MPIe1f M Tdolkfl.) <br /> AFFLICATION IR NEW NY NACF IO TM MN JOAOUM COUNTY FOR A M. M0 TO CONSTRUCT ANDpn MSTAM THE WCP OEeCMM.11118 AMtICAT10N IS MAGE IN COMPLIANCE WHIR BAN <br /> AACWN COUNTY DEV[LOACM TMLE.CNAPTEERNO <br /> R a-1116.3 AND TIRE RFAAROS OF MRN IOAOMN COUNTY PAXIC HEALTH SERVICES.ENVIRONMfMµMA rN M.N. <br /> .wB AMEKSAM APNG & <br /> F <br /> 67/ /A.N 17. Curr, 60,Q), y vA11L1LeIEE/AMIE <br /> ox{IEn's NYA{E [�.p V N AENNAE a ,�E \n a xf') (.• MwNE E 3 3`J' l 2 63 <br /> COMNmT / Ross AOOMEH /.ted/J (7F IMI 773 -f •J�E, e'_ J <br /> WB COHTACTO rtVC SZ PU)m S ADME.. Loo i HCf M HE E36 - 3139 <br /> 1YFE OF WHLA'UMr: PUN NFN V/Ell ❑rueF .MEM WRL ❑MONOORINOWELLI 13 THEN <br /> ❑M.TAUATgN ❑ SBTfM MU. AFFAIR ❑....CONNECT NEPNR <br /> .q ❑VAPofl FATPACTpN WE41 J <br /> S II N L7 Pp.b .�A H.P. D pEpN VMrS <br /> NYFf OF R1MM HFURT WATER UWL <br /> I-,) D <br /> ❑OV1 M EIRMSE WEIR ❑OEOMIY.Cµ E <br /> WE. .OIL.MNO R <br /> ❑OFSTPVCTpx: <br /> IHIfN !O VEEI EDF WELL CO eTR IOF wlcM.A A <br /> ❑INWITMµ [❑ommoOTTOM MA.OF WELL EXCAVATION ffJJ LL OM.OF CONDUCTOR CA.In. b <br /> �'.MERINM1NVAf J610MVEL PACNHNE TYFE Of CA.INO/MRIRVC(� MA.OF WELL CA." tl L O <br /> ❑ILBNCOAIIMCNAI ❑OMVFN OFRHOFO.VTEEAL 1 O`er .ICe.PM�`LfBD B <br /> ❑IMNIATIMPAO 13 OTHER O.NEEµIN.TALEDIII Gn,'(n O.VT REARED NAME C&k22 '1--) E <br /> ❑MONRONND f.{ oEXweEALFVMO: Y <br /> p V1]NF CONCIIAF FFDE.TµBV DWLLfn:C7YF. QNp J <br /> ARRIM MR," -3 3-2, 1 tL21 LOMCBI.CHE.TEA EOXISTOVE RR E <br /> Mv.EfO CONE111mnom RWNO MRNSEM SU01wTARY K AIR R]TAAV AMER CABLE OTHER <br /> I.YRV CFMIPY TIMT 1 NAVE REPAREO TMB A1511CATNIN AIw TEAL THE NV ME NAIL BF OOMF IH ACCOIwA.E WITH MN JOAWIN COUMY O.INANCEB..TATF UWe.AW RULE.AND <br /> MOUIMI.M.f1weANJOAOWNCOURTY.HOW OWMR OR WEN.ED AOEM'SWMA1.M CNEETWE.11.FOLLONt.:'I CMI THAT RETIRE PffCORMANLE OF T11E NSR(Rb XMCCR G <br /> IHM PENEST IB I.WED.1 E11AL.T EMMOY MRSOM GURJECT TO WORNMAN'e EOMFEN.ATON"We OP CAOORMA,•COMMCFOT.HEENOOR BURLOMMC{IND BIONATVIIF LEMIMF. <br /> HE POULOMM: TI"THAT IN I'M OF Till <br /> EN MR"CH SHIP TERMITE 19 HISINFO.I SHAM. <br /> CAIFOM.A.- IFICE^�M.VET SAM 24 M..1. SON AM M..MUNIEOoN.AT 1HNI.Y-.{E..COMFLETE REMAINS AT WINE,AMA ARONCEPdEAT.MUW.OF L <br /> S-2.7-97 <br /> not AAE IN.I.B..w a.ir •x T <br /> 1.NAMES OF WMEE MOR....NEAREST TO OR.UNOFM THIS IMPURITY. E.LOCAISMOFN...I 8FVMGE MBWML.MEM OR Mb.MO <br /> I.OMUM 01 TK 1TOFIRTY,MMHO OIMER"Nu.ANO NORTH IMMCISM. EXPANSION Or.IYAOE DIB..A WMFMB. <br /> I.MMEN6MNEb OUTI.W..S ANO LOCATION W AL fXIRMO AM Iw.MO E.LOCATION OFN'ELLB WAREN MO . M <br /> NS OF OM MO ,M,FT. <br /> STRUCTUME,MCLU COVERED AREAE SUCH AS PAroB,DNVEWAYS,AM WAXB. ON TIE PINPEIRV aN AOJMNMO IMPURfY, <br /> 19 __ <br /> 3aRN X itAAI v <� <br /> .. <br /> LL r.1 <br /> Do. ESC <br /> A. VN <br /> es <br /> .. - ,�.. 777 <br /> O ve wa C,ppa"Fit aG;U r1r <br /> :. I .r.. PU01-I0 HBALYH SEHVIQES <br /> dNVI(iONWWAL HEALTH'DIVISVJn -w <br /> bnMFMENT USE ONLY <br /> AepN.n.n A...PIr ar ��MM1 b.. 5- 7...'1 M..�'ZL <br /> D:.0 I...FmxM 8, _ _ FIAT _ _ -_ 4131417 P.n,1:.r..uH,BF ^•'eeP 1 0.1. -rr�47 <br /> A <br /> ..mn.A.: CF_.��FJ r83-11a <br /> .......IN,; AD, rACP �jO/2G2 <br /> NCO.. MIN. MOVNF RENITTEb 96C AfH R.FAEE FY OATF FRN1pSFRWCF n[WUI MIM.D1 MVMCE <br /> 3 D3 D <br /> 6 3 AFD <br /> Pub.HoWIT,Sew.-EMm,173(3/96) <br />