Laserfiche WebLink
APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JDAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 3K 904 EAST WEBER AVENUE,STOCKTON.CA%MI. 86 <br /> )209)4683420 <br /> NON-RUUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> ICM UPIAIA M TTIPiLebl <br /> Ag CATION It$KRE DY MAGE TO THE BAN JOAQUM COUNIV FOR A KWIT TO CONSTRUCT ANPAM IN6TML THE WOM DESCRIBED.TH111APPLICATION IS MADE IN COM%1ANCE WRII SON <br /> AAWWCOUNFYOEWLOMWTTRI^F/.CHAHOO-1116.3 AND TIIE BfANOMOB Of BAN JOAWIN COVN/]V RIBL1IC IttALT11 BEMICER,ENVIIIONMENFAt1 THUM610N, <br /> EBBN (O C) / <br /> 1.6 ADDRR AMI / 1 ///t-- 2 CIT! /9 yI,� PA.CM. F1APN1 <br /> ONWfn'R AMAW1N, .�/�A)I � %HONE, 334- l2.6'3 <br /> C"MRAcron. Kp�'IT li A".d SS MDMee�d �tjE 27� LI IM3-p5 FHONEI�3 y" y�2� <br /> nub E.MrwTON L 1py.-'SZL&Z �L/Yn VJs ."Has Zoo 1 M. PHDNEF36a— 3139 <br /> TYPE Oi WEWRIMP' Li NENWELL ❑N,.CEMEM WELL ❑MON%ORINO WE.A ❑ Em" <br /> D❑1 WRIALLATION ❑WELL MY6TEM REPAIR 11 Chose..MRCT REPAIR 0 VAPOn ERMUCTUN1VV LL1 J <br /> zy N—cl Ry , H.% 3 Vu ,,RIMPRM_M. FIRST WATER LFL L O <br /> HYROFgIM% <br /> 11 OUT-Cr WELL ❑OEOg1V6FAL WELLI ❑ eOIL BO11W0 B <br /> ❑OUSHUJCTKRP <br /> XTENDEO USE type OF WELL COHBTRUCTMN SPECIFKAIOMR 1l A <br /> ❑WWeIMAI (10KNBOTTOM CIA.OF WELL EXCAVAMN �-- OIA.OFCONDUCTOACAMN0 O <br /> RwNA ,,CAWVMC jw.R TL PAwwTY PE.ICAIPUEPWPUUINCp V DIA.OFWELLCAMNQA O ' <br /> ❑%RIICBNNKRAL ❑MNEN DFITHOf OROVT 6FN �LHF <br /> 430 SCIFMATIOH r-cis O R <br /> ❑IPAIOATgWAO 0OTE9 OROUT SEAL WBTALUEDY GIA.'rll PROUFBRAHOHAMSNAME CeC� E <br /> ❑M.NUMEUIHL as GROUT REAL%IMPEO:pV« ❑N. CONCNEIEPEDESTN IWUR 11II ❑N. 6 <br /> s7 y r <br /> APTOR."ERN J �' �. LOCEINO CNEBFER BOnIBTOVE%PF d <br /> MOM.EDCONITnUCTIONORMULENO...; MUDnOTAM X AM POTARY AUGER CAME OTHER <br /> 1 HMRY CERTIFY THAT I HAVE EHFPAREO TNI.AMULATpN ANO THAT TNF WOW WILLIE CONE M AMOROMICE WITH MN"AOUIH CWNFYOMINMCE9,STATE LAWS,AM RVIES AND <br /> NEOULATIUME OF THE BAN JOAOUM COUNTY.HOME OWNER OR LICENSED AOEM'R SIGNATURE CERT HEC THE MUOWINO:•I CEMOV THAT M THE PERFOHNANCE OF THE WOW.MR WHICH <br /> THIS KEEPUT 1R ISSUED.I BIIALL NOT EMPLOYPERW MS METJECT TO WOREPER H'S COMMNSATWN LAWS OF CALFO ENIA,•COMMCTOnB MryHOOh BUBLOMMCTINO MW AIUIG CFRfIFIFn <br /> TIE FOLLOWING: 'ICERTIFY THAT M THE MIfORMAMEOFTIN WOM FOR NNM:H THIS KFAUT 10 ISSUED.I SHALL EMFLOY PMBON. U-IUCT 1D WORWAN'F COMPdEATON UWB OF 1 <br /> .� CAUFOON T�NF/jPPU,E A,NI MNTCA WUPI F IN ADVANCE FOR ALL REOMREDr ft <br /> AT(ME COISIEHi OMVANO AT LOWER MEA IMNOEO. •J <br /> :,M,U x fin. Tn. ft AAI Aiel/ <br /> PROT%AN M,—,.B.w)SONS m <br /> I.HAMCS OF STDEETB OR ROADS NEAREST TO OR BOUNMNG THE FRORIITY. ..LOCATION OF HOUSE SEWAGE CI)PoBAA SYSTEM 00%gIVSID ' <br /> z.OUTLINE OP TIES MOIFRry.WHEN.OBEH <br /> ABroHB D <br /> ANT,NONE" RBCHON. EXPANSION OF SEWAOF OIMOUN.WSTEMC l` <br /> ].OIMENRNINED OUTLINES AND LOCATION OF M FMTfRq Ruff MOMBEO I.LOCATION OF WELLS WITHIN MORA OF ONE HUWRD TIM <br /> STUCNKB.eu LUDINO C,HfSMO AWA,SUCH AS PATIOS,OFIVEWAYS.AND WALK". ON THE MOMMY On AOJOHREM MUKUPPY. C <br /> /Sb ✓ Kc� N <br /> �JA.1fd X <br /> �. S IJ .� <br /> Yf4 ._ <br /> ,^+F li GGa A uu IrJ r <br /> 6 ,HQ LtFI SE V+CES <br /> < .. .�...,,. . ...<.cNVIRONMo",N7{tL F{EALTH-OIVI$L ES ....� ;. <br /> _...i... <br /> 1 <br /> DEPMTMENT USE DMI <br /> .I Nr7- 1-Z-1Ags.1m M1wSL � ON. <br /> It <br /> r73 <br /> CLq] <br /> 183-11 pA <br /> A<cOUNTI.."NIT NOB FACE <br /> W�S.. 1EE EWO FJAOUNT e—ITED ICS CAIII MC1M1"E1 OAT! PFNAI\ISOIWCI nEWlAT NIISYFn Uhnnc! <br /> 3-5 <br /> 03 0 <br /> 0 <br /> OO 12-6—V,7 <br /> Pub.Health SSW.-EW..173(3196) <br />