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11 <br /> APPLICATION FOR WELLIPHMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX BBB.3D4 EAST WEBER AVENLF—9TOCKTON,CA 95201388 <br /> (2001420-3420 <br /> NOO"EFUNDARIE PERMIT ESMNE8 1 TERN FROM DATE ISSUED <br /> Rages I.TLy4bl <br /> IPRICAtM MFRRE FY MAOI TO YH[BM gAO111H COUNFV FOR A FENLOT TO CONSfMICT NOgR WCTNL TIIE M.OIR OaC1 TNM YRICATgM H M!➢E M CEMg11WtE WTTN Wl <br /> bAOUM COIA'RY O[V FQWNT TML MkFTFN 9-1115.9 Ma YNE rr LNO M OF lµA4O11M CO1[M�1Y NBLIt KµIM Y[1MC[8,[H'NMMi FNµTN WFOON. <br /> .AB MDIEewn•rrl/ �QE� / �(/nu ri Yvl a N ary )�bc�� rAleEL el]MAnu <br /> ONMGY MAML-1 � y!� lit <br /> •wMo o'j/oIfO�RE�/[���r C/w9 i✓J pw�al[E L/��1�e6� <br /> aaNTRAy Cc/,,)';'Y i-I !� AOOREa TY. } KI IM�e IICI W>'Y�J[_RIdY/rv6)793.� <br /> BDI CONTRACTOR AOMIEY uC, —PEO.E, <br /> TYPE OFmumlAw O New WEu O REq otvHi NEu O NoFwToNNe W O <br /> ❑NRALL•TRM O v e,L n ,m AMR (3 tws aNwwT REFAN O vAFT1 uTRAC1AN Wnt F j <br /> ❑Hes ORRVI. N.r. pERN PUNY Kt R. FAVI WATU LEKL a <br /> RTFFT PULq <br /> ❑Wf-0FB91VK[WELL)/ ❑O[dHYMCµWELL F ❑ BOIL WIEMO I <br /> 0 FT _ <br /> INOORHµ ❑OPMOOT w OM.OFMM"CAVATK)N CSA.OF CON TOR CIIMO D <br /> 130a4[RY_IPHVAiE ❑ MXI aMt1L P - TYfi OFCABIHMTEEIAW' OM.aF WHL CABYYd D <br /> 13NM1GMlMICNµ 13 ONY4N O[PTHOFaRODTaµ EFEt .VmoN F <br /> ❑ONOATbWM ❑OTHER M10uF aµMBTNlfl]EY Miom mw.o HLwE <br /> ❑MOMFOIBxE orpvr BEATPDIAP[D:11YF. Ow eONcrET[PmeB*A Er DIRLu.'Or. Ow s <br /> AFPIIOL a1TN LOCRNwL CNERTER EOvvow RH_ 9 <br /> FROMM COaTERK'NONRMWNG MRIPO: FMN)mr,NY__AM NDTNfY Auau[__CA OTNM <br /> IMY[Y UFO"THAT I HAVE MIEpARO TMB N411CATM.. n4T THE WOAR WILL a CpN M NCCOfiO 'W WRH MN JOO COONFV OIOINM:[B,STATE UW1.Mq T *MO <br /> FEOOLATMHB OF THE BAN JOAOIIIN COUNTY. NOW OWMER M WWW AOENT't EpHArLHI[C[ROHG THE FOLLpWE.q:'I QIR.Y THAT M THE E8101aI:NC[OF THE NOIR PON W111CH <br /> N <br /> TRIaMT M 1BBM ,I R NOTE RERUNS BI1Rl[CT TO WpYALAIYE CO mm LAM Or CAJFOM.r.-CONTMCTOR'B H~OR RNLONfNACTNNI BpILATUIE vmn"B <br /> THE IMLO'MM: THAT M M REEORyNIt[OF TIE WoM FOR WHF,H THN rMW!IF NB b.1 RIALL Fa PE ,BUM TO MORpAMYB OORPE.MTNIR IAWB OF <br /> CNIFORMII.' __--77A//R_i MMT Y HOW M ADVANCE FOR ALL.REOVRBOM!/'/ RE AT raBE WiAif. COMAlTI pMWa]AT LON9I ATEA FFOV .. <br /> I <br /> WW E / ThH - r D... / 1- <br /> FEOT <br /> I. NN,IE M EIIQ]B 011 NObB MA1fRr TO 011 bUAIHO TM MOFERTY. `� .. VICATON OF mum WHME ONWOML MIEM On F ,OP V <br /> ]. DNUN OFND O OLINF1 Y. tOC .N OF A q XW.AN PNOV ION. [RR/NMON O/BEWAOE pWOML[YFfOIB. <br /> 9.OMFNYdIEO OVIINFE CO IACATON OF AL E%IRMO MO FI AVO B. IN THE N OF NE D WNMH N1MIN OF TIE MIAgED FFTY R. <br /> EIl1UCIUlE0.MCLupIq COVFIFD AIFAE WCH A6 PAibE,MK1'IAYE.AIA WA],B. ON THE RORIIEY OR ADA1NNl NOlE11TY. <br /> .. .... .G . ' :. ... <br /> 4 ., . <br /> i. .i ... ., .. : .. <br /> PAYMENT <br /> NQS 01995 <br /> --n fir .. .. SANJ <br /> PUBLIC#IEOkLTHSUuvIY€ <br /> .. <br /> WC <br /> " NVIAONA TAI HCALTH DI\/ISIQN .. <br /> DOANmer.1 ONLY <br /> my__] <br /> DU. MY DR. <br /> ACC01M1WO OMlY; AOI FAC, <br /> M aoOa AA "W`T`w a Aw NECEVa Er DAM PB1REr.NB11V10E REOU4r NVY.1 u1V010E <br /> 730 0 a! 2 >-o L6vL 4,- +I a Oa 9 <br />