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APPLICATION FOR WIMPUMP rERMIT C'c:'i:►
<br /> .J SAN JOAOUIN COUNTY PURLIC HEALTH SERVICES () c }(fI
<br /> G-. ENVIRONMENTAL HEALTH DIVISION i
<br /> BOX 388, 304 FAST WEBER AVENUE, STOCKTONI CA 9MI_388
<br /> 121191460-3420
<br /> MOR REFUNDABLE�ERINIT EXPIRES I YEAR FRR�! PATE ISSUED
<br /> framplofs
<br /> AM1ICAII0N la NME RY MARE'►O THF.RAN JOAOU04 COUNTY Fort A FY;RMIT TO CONRTRUVtrA ryEen 1HRTAlt"IF WOltK RFrrnlREt),11119 AMtCATION IR EAAOE IN COMPLIANCE Wi711 A
<br /> JOAn"in COUNTY DEVELOPFAENT TlFLY.CHAMEn 9--11 T5.11 APID TIIE STANDAMM Oi RAN JOAOIfIN COUNTY IRM 1lf Al,'11i REnvlr,Ee,ENVIRONMENT Af.1fF.A1.lH OIVfPmi-I
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<br /> 1-� 101A.OF WELL EXCAVATION
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<br /> OPORED CO"ItTnUCT1ONID164UNO MITO
<br /> ETO: MUD VOTARY /K 5
<br /> ^AIR ROTARY Al1QER CARIE
<br /> _ OTHER
<br /> I IIF"YF(HPIAT CERTIFY THAI 1 HAVE F'I IH Co f THIS AT►`LIC Ai10N ANO THAT TIIE WORK W11J.RE DONE FH ACCOhRANCE WITH PAN JOAOIIIN Cdl1TTTY OMiHANC£A,RfATE TAWS,AHI)RULER AFI7) '
<br /> nfRlll ATld}fS bT TIIE RAH.IOAOVIN COUNTY, 1lOMF OWNER dR LlCf.NPED ARFIIT'R RIRNA7 URE CERTIFIER TIIE POLLOWTNO:y CE.nTIFV 71lAT,N TITS TtdiTFQl1MA So A of TIIE WdllC TOM WI11Cli
<br /> YI IrR IYRMIT iA IGRUFR,t 611A1L NOt EMM.OY PFRSdNB PVRJECT TO WORRMAN'R CpMPENR
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<br /> LAWS OF CALROITNIA.' CbHTRACTOR'A NIISIN(T OR RLlR '
<br /> TIIE 101,1 OtMNn; '!CF,FTTIM THAT IN THE PElIEOT1MAHCf OF T11F WOhK FOR WI11C}{tNpR f`EhFAfi 1S ISSUER.1 R,IALL EMPLOY TERnONe R,JRJECT TO WOR►(MAN'A C MPENAA FlpF!�WRIpr i
<br /> CAI_IFORfSA•' THE APPUCA T MI1lT Mt!A HOUR•IN AIIVANCE.FOR ALL hrnUInFD INAPECTIO"$AT'"ool ASS'2.I73, COMPLETE OnAWMn AT LOWER AREA r1nbVIT,ER. 1
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<br /> 1, NAMES of PTREETR OR PARR NFARERT To On ROIJNRINn TIIE M,OPEn-TY, - •1n'"--- ` I
<br /> 2. OUMMF OP THF rno rEhTY,OIVFNO DIFAE.NSM)"O AER)N0R711 OInFC710FT, A. LOCATION OF IIOURE RFWA(I£DIRMOAL PY4fTCI.1 on IMM MITI
<br /> 3. OIMEHPIONFO OUTLINER AND LOCATION or ALL FX"RM AIR)TTTnrQRFR EKrANRIOIi OF REWAOF.T)ISPORAL PYATF.MR.
<br /> BT171JCTl1RF9,INCLUDING COVERED AREAS SUCH AR OATIOR,DRIVEWAYS,AHD WALX R. B• t�ICAIIQN OF WELLS W1T}Ifll nADryIR or f1N1:H[Hff,oED 17TY iT,
<br /> - ON TIIE.IYTOPEnTV OR ADJOINRlO 1'l101":hTY,
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<br /> PF CdT,rs - FEE INTO- AMOUNT RtMITTEO CI1FC- MA911 RECEIVED AYKATE
<br /> PEt,MlTIRIT,v[cE REQU£lIT NUMPFR - tNVO10E
<br /> Pub.liaallh Sew.-Enuiro. 173(3196) ----- ----
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