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APPLICATION FOR WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 344 EAST WEBER AVENUE,STOCKTON,CA 95242 �©Fly <br /> (209)488-3420 <br /> D •R UNDAB EAIRTT EXPIRER I VAN FLOR BATE ISSUED <br /> IC"Iltl I/TFIP&MRe1 ' <br /> AL AUUM RRT m MERE SY MAGE 7a THE SAN PTMJOA9-1 COII/rI r FOR A RENOT TO CONSTRICT AHDIOR PWALL THE VAIN CESCFJSEO.TIES APFUCATION in MADE IN COMPLIANCE VM,/AN <br /> JOAOueE COUNLY OEVELDPNEM TITLE.CHAFTlR B-1 T 6.3 ANO THE/TANDAWB OF BAN JOAOU/V COuNrY FU C HEALTH SEnNICEB.ENVIILDHFJlNrAI HEALTH brvlmON, <br /> JA AOOIIESB�O/I AEN/ <br /> CT" FAMUL SIZEIAPHR <br /> �A �. <br /> OWI/EIY/?IAM! AOb11ESB 15.1 P�bME <br /> CONTRACTOR gUq <br /> A. U BION;• W <br /> Sub cONTRACToR Ai <br /> AODFEM VCE_ FNOFR• <br /> nZL2Ltmjnm ❑NEW WDLL ❑REMACEeEFNf WELL ❑MOWROPJIIO WILL E ❑4fNDL <br /> ❑evar TIDH QEM RE►AR ❑cA08"ONNEC£REPAtR LlVAPOR AC <br /> EUYRTION WELL F <br /> RYPE OF PIIMPI <br /> ❑Nw. S.v.lr N.F. O!T'IN ruw eLT-Fr. PRLIF WATER LEVEL O <br />' ❑Mm.*F-SEYNICE WELL ar. eIC WEILJ ❑ <br /> EDIL somna s <br /> i OEBTRVCTIOM <br /> I Y OF T <br /> w <br /> IIm wmAl ❑OPN/GOTTOM IEA.oP NEIL EIICAVATPON DIA,OF COWDUCTMCASMO D <br /> ❑COMEOMM"'VATE ❑GMVIL PACKANZE� TYPE OF CA=*"TtaA-VC_ S�E _ Ou.OF WFLL CAI M0 <br /> ❑IVSl1CArimcIpAL ❑LIIRVEM DEPTH OF WWVr SEAL PE <br /> _ SCIFICATION <br /> wA <br /> ❑bwATe71CAG 11OTHER CROLIf•EAL MBfAl[Ea by OIgUT IPLMIO NAME <br /> ❑Mo"rorma oROVT SEAL WMIED-❑V. QN. rnl+cl0.ri FEbfBTAL Ln ORILLRR:❑Yw ❑M. d <br /> APFMX.beiFH "WRING CWESTa SONISIOVE AE s <br /> PMFONb MNffRLICTIOMIOIELLBID METM*5 MUD MTARY ABI ROTARY AUOEIF CAU- OTHER <br /> I IIE.E/y CLITTEY THAT I HAVE FFEPAWD TNN APPLICATIONANO THAT THE WOIIC WILL SE DONE 1M ACTCOMAN"WRM RAM JOAOIIIN COUNTY ORIMMAMCER.RTATE LAWS.AND FWLEB AND <br /> N/ <br /> IgaULATIpOF THE SAN JOAOLIIII OOIIFITV.NOME OVMIER OR LICLNlFD AOM-0 bgMATUIX CERTIFIES THE"LLOWDq:•1 CVWWV THAT IN THE FSiTORMANCE OF THE WOFK FOR WNICN <br /> TIM PENIMR IS ISSUED-l SMALL NOT EMI Lay POSED"SU6JECT TOW011MAN'S COMFSIISARON LAWS OF CA11vNAA_•COMMCTDIY/HIRING OR LEJ/iOMMCTbiG ROWAiIMO CETITRTF/ <br /> THE POLL /I •I ClIKIFT THAT A ALL PERFORI.IANCE OP 7IIE WORT POA WMCN TMB IF NBUEIs,1 sFALL FEEFLQ7 FEFWM BUB.N TO NDFS/MAN'S COMFBTSA71oG LAW/to <br /> C A.' rNE AFlMIE M CALL'� B a ALIVAIICE FM ALL FSOIFIO M 7MNS AT rmq IM.f4i1-COe10.ETB DIIAIIRIID AT LOWEIL 111E DCO <br /> S7G.a!1 7Lt1. Dw. <br /> FLOY PLAR Rh...n Eh.l.l Bv.1. •q <br /> I.MALR1 OF"POM ROADS N[A11ESf TO OR/OVNDIND THE PFIUFERFY. 4.LOCATION OF NOIRE SFWAOE DnWg@M SYSTTM OR PROFOSEO <br /> 2.OLRINE OF 11N poFFNfY.ONM DRI[NS om AND NOMM DINLCroN. EXPANSION OF BEWAOE OISF9BAL SYSTEMS. <br /> 1 OMEEEIROII[O OVRRO,B AMD LOCATION OF ALL F1LNfSIO AND PROPOSED E.LOCATION OT WELLS VkTffeN Ijyd CF ONE MuMOIEO FFTY FF- <br /> eLRUCTUREB,WCLUOINO COVERSL MEAS WC"AS PATIO/.DMVEWAYS.AND WALILB. ON THE PFATPEM"OR AbJOI VMPEFRY. <br /> 3 IO 1 : hlo <br /> :.. :. <br /> we <br /> �N,,�X b� rc��u4a♦r;.� . .. <br /> 1�. 7C1 <br /> .�arl�e�ruweoLlw:;r <br /> PUbL1C HEALTH gEFNl�t=9. <br /> - - - - r INVIRDN�'1EN7AL HEALTH bn1`UN <br /> f <br /> EIIeMMn MPFATMENT V DRLY -71 <br /> AFAwgl.d EK L 0. A.- <br /> _ 11 /( �A <br /> D..e.�wy..Rrp+uer ST INH. <br /> C (..f.��TJ+t' 1 <br /> ww '75 4 <br /> ACCONN11M0 OMNI NDE £AC/ <br /> W COON FEE INFO AMOk MT MMTltb CHECRT ANI NECENEO/Y DATE FBKWTM91NCE MOCTIT IMVOICS <br /> 05-1 D3A II' 17 <br /> Pub 4Sslth Se .-EIMfO.173{l 197) <br />