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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> RObREFUROASEE PERMIT EXPIRES 1 YEAR FROM SATE ISSUES <br /> IOOdPMM M TFbRtldl <br /> ARAWAININ IB PIER 6V MAHE 6 OOVMCO FRA FORUM TO CONSTRUCT AMM d61ALL THE YARN(MICNISEO.THIS AFFMATNIN Ie MAD:Ix COMRTANCF WMI IAN <br /> JOAWINCOUNTVpEVFLORJJ�^EI{� /nf/nI1 THE 6TANOAMPT OF SAN MAXN COUNTY RMUL HEALTH RRACIA.FNNbNMEMAL HEALTH DMBgN, <br /> J06 AODn66ATR AVN/IJ/V1 J'�v �D7 �3I� CRY/ PARCEL 6NMAVNF <br /> DAAAR'6NAME Cc 1o1))7pw7 A... � {�4w. nmer M.EO,'_I D33/ <br /> LOMMCIOR 14". <br /> Y -l•"I1 AOORE6ep�1� C U/ lACCE(a0J(sW_1_�NEF hu4n9n3%f( <br /> RUSCPPNT.MR T771�' ApdESW(J S-k E,-/I 11CI�,/TpjS IN OM.-ol /- <br /> IVFOOi WELI?IIMP. ❑NfWYrFLL ❑IIFRACEM(M WELL .MOMONM WELLI ❑OTHER <br /> ❑MOTA11AMN ❑WELL SUBTEM RPAIR ❑m. .UAIICT RFFAIR ❑VAMRIMIRACTIONWELLF J <br /> ❑.-13F FK N.P. OEPfN FUMFSFT—R. FRUIT WAIER LEM 0 <br /> RYn OF MARI <br /> W6EL.f neG ¢-�oLMaF.e[RYKT WELL ❑ Ea Lwlu eoMRxa e <br /> ✓L �/? IN f7�"Yfyf w•%>f f3�vC.4rE❑ R <br /> N <br /> �(OfrtMAnpx:..Ja.l <br /> PATLO UfF ITT.OF WELL CON\1RUCRUS EPFCIRCAH.H. A <br /> ❑INWWNU. ❑onx.OITOM DA.OF MLL E.C.M. DIA.OF CONWCTORCAEINO O <br /> ❑pOMESF)K6NVATE ❑OMY[I IACARDS TVn OF CASIWRHHTFLA`VC DA,OF"LL CASINO O <br /> ❑nISLKNAUMCdAI 00"N OUT"OF OroM\EM 6nCIMATpx R <br /> 11IMOATbVNIl10 ❑OTHER --U nr Ld6f---SY OPoUT SAM WINE F <br /> ❑MOMFOMHO dtlUF SEAL MAIRII❑VIA ❑IM CONCPETFFOOFSrµSYpP1LLER:❑Yr ❑. S <br /> AFFROR.... L..CNERIR IWXAHP VE Rn IT <br /> FMENIM CORITRUOTONSP LMO METHOD:MUD MTAM AIR MTAM AWER CMLE OTHER <br /> I HERBY Cf MIFY THAT I HAW n1ESUSIM TWO A AMAI AND THAT THE YAR[HIRE SE MR M ACCOMMKE M1FN SAN MACRON CWNFY OFOINANCES.STATE LAWS.AND MISS AM <br /> DDRAMINP OF THIS SAN"Ag COLMTY.MOTTO fl OR LICENSED AGENT SIGNATURE CfMNIES THE FDLONTO:'I CERTIFY THAT M THE FORfOMANICE OF TIN MISS MR WMCTI <br /> TWO FON.LM IO IBO1N0.I UTALL MT I610.0Y FOUXU S SINEACr TO THOUSANDS 9 COMn IAF W N LAM OF CALIFORNIA.-CONTRACTOR'S HIRING OR O S"OMM1 11M MONATUPF CEFFNIT S <br /> IIN MUL. .1 C IRI THAT IN TI nWONAAMF OF FNS MORE MR WNKH TMO IS IOOUFO.I:A L EMnOY MAMNS NSNCT TO WORWAN'\COMnTTOAHON"WS OF <br /> CALIF.PM C M MWT A H SMwU.�I�N ADVAM\MR ALL RFOURtl IX\ NS AT 1 1 Etl.MM.CO /Ed/1�AVA�M AT MN[R ATEA FIONOfp. <br /> llryrlAiln. ��� <br /> nor TUx nTFFE <br /> I.MOTIFS OOFINSMORMMSNND DA 10 IMUNNET <br /> M.I RC11011. 4. LOCATION OF MUSE EfWAOEdSMOTI SVrtfMOR ROMBEO <br /> i.OVILOR OF INE AOnRfY.OIVXIO OIMEI OHS AM M.d1ELlOH. fAFAMgON OF OEWME d\MON SV\l[M\. <br /> ],pHERNSIONEOOMIMFOAWRIMATONCFA SNIBTMOAMROMOEO L.LOCATION OF WELLS WITHIN RATRUS OF ONE W)NDDO TI�T'n. <br /> STRUCTURES.MCLUDM COV[IEO APUS 6UCM FAIOO,dEVEWAvt.AM.1, ON THE R10RRFY OR ACM.nOnRTY. <br /> COED <br /> o� <br /> SAL �//R ,, DnASHII.Ivie ONp nq <br /> ANASS.A..RI.e Ls „ \ ` f'1"^'w�w D.I. �'E -L EJ A.P. i4p, <br /> _r <br /> c...m <br /> AccOlW nxe Oxtr: AID' FKF <br /> FE COCF\ Fd IMO AMOIMTR[MTFEO CIRC6ERA\N RML 11Y O.LrE TI[MII.—CL REOUE\T HISWOI I... <br /> a°lo,)- o 2-eA3 -m awl o(rte <br />